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Peters S, Peebles E, Carwana M. Lost in translation: a national cross-sectional study on medical interpreter use by pediatric residents. Postgrad Med J 2024; 100:504-511. [PMID: 38453142 DOI: 10.1093/postmj/qgae026] [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: 10/10/2023] [Revised: 01/25/2024] [Accepted: 01/27/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Lack of communication in a family's preferred language is inequitable and results in inferior care. Pediatric residents provide care to many families with non-English or French language preferences (NEFLP). There is no data available about how Canadian pediatric residents use interpreters, making it difficult to develop targeted interventions to improve patient experience. OBJECTIVES Our purpose was to assess translation services in pediatric training centers and evaluate resident perception of their clinical skills when working with NEFLP patients and families. This survey represents the first collection of data from Canadian pediatric residents about interpreter services. METHODS Eligible participants included all pediatric residents enrolled in an accredited Canadian pediatric training program. An anonymous survey was developed in REDCap© and distributed via email to all pediatric residents across Canada. Descriptive statistics were performed in STATA v15.1. RESULTS 122 residents responded. Interpreter services were widely available but underused in a variety of clinical situations. Most (85%) residents felt they provided better care to patients who shared their primary language (English or French), compared with families who preferred other languages-even when an interpreter was present. This finding was consistent across four self-assessed clinical skills. CONCLUSIONS Residents are more confident in their clinical and communication skills when working with families who share their primary language. Our findings suggest that residents lack the training and confidence to provide equal care to families with varying language preferences. Pediatric training programs should develop curriculum content that targets safe and effective interpreter use while reviewing non-spoken aspects of cultural awareness and safety.
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Affiliation(s)
- Sarah Peters
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Erin Peebles
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
| | - Matthew Carwana
- Department of Pediatrics, University of British Columbia, UBC Faculty of Medicine Rm 2D19, 4480 Oak Street, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
- BC Children's Hospital Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada
- University of British Columbia, Human Early Learning Partnership, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
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Ramafikeng MC, Marshall E. Navigating language discordance in public health care in rural South Africa: a qualitative descriptive study of occupational therapists' perspectives. BMC Health Serv Res 2023; 23:867. [PMID: 37582788 PMCID: PMC10428555 DOI: 10.1186/s12913-023-09658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 06/06/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Language discordance occurs in healthcare when staff and service users do not share proficiency in the same language. It is a global phenomenon impacting on the quality of health services, as person-centred practice requires communication to establish partnerships and rapport. In a country as linguistically diverse as South Africa, effective ways to navigate language discordance in health care are urgently required, yet there is limited research. This study aimed to describe how occupational therapists navigated language discordance when working in the public health sector in KwaZulu-Natal. METHODS A qualitative descriptive design involved using purposive sampling to recruit occupational therapists as participants (n = 8) for 15 semi-structured interviews. Thematic analysis was used to analyse the data, which included reflective journal entries from all participants. RESULTS The four emergent themes were: (1) concurrent use of strategies, (2) I'm doing as much I can, what more can I do? (3) Language definitely impacts that therapy process and lastly, (4) systemic oppression perpetuating language discordance. CONCLUSION Language discordance is a complex context-specific phenomenon, therefore insight into concurrent use of strategies is important to practitioners to enable them to navigate language discordance and ensure provision of quality services. These insights are significant for healthcare professionals and resource allocators as they shed light on the shortcomings of advocating for a single strategy such as providing trained interpreters. Successful navigation is characterised by determination, being kind to oneself, willingness to learn and use of pragmatic and flexible approaches. To prepare to navigate language discordance in a low-resource context, education should extend in time and scope, to include multiple strategies, culture and relevant languages.
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Affiliation(s)
- M C Ramafikeng
- School of Health and Social Care, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - E Marshall
- Marshall Occupational Therapy, 3rd Avenue, Kenilworth, 7708, Cape Town, South Africa
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Sellen K, Markowitz B, Parsons JA, Leece P, Handford C, Goso N, Hopkins S, Klaiman M, Shahin R, Milos G, Wright A, Charles M, Morrison L, Strike C, Orkin A. Considerations for the design of overdose education and naloxone distribution interventions: results of a multi-stakeholder workshop. BMC Public Health 2023; 23:888. [PMID: 37189052 DOI: 10.1186/s12889-023-15554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/28/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Opioid overdose epidemic is a public health crisis that is impacting communities around the world. Overdose education and naloxone distribution programs equip and train lay people to respond in the event of an overdose. We aimed to understand factors to consider for the design of naloxone distribution programs in point-of-care settings from the point of view of community stakeholders. METHODS We hosted a multi-stakeholder co-design workshop to elicit suggestions for a naloxone distribution program. We recruited people with lived experience of opioid overdose, community representatives, and other stakeholders from family practice, emergency medicine, addictions medicine, and public health to participate in a full-day facilitated co-design discussion wherein large and small group discussions were audio-recorded, transcribed and analysed using thematic approaches. RESULTS A total of twenty-four participants participated in the multi-stakeholder workshop from five stakeholder groups including geographic and setting diversity. Collaborative dialogue and shared storytelling revealed seven considerations for the design of naloxone distribution programs specific to training needs and the provision of naloxone, these are: recognizing overdose, how much naloxone, impact of stigma, legal risk of responding, position as conventional first aid, friends and family as responders, support to call 911. CONCLUSION To create an naloxone distribution program in emergency departments, family practice and substance use treatment services, stigma is a central design consideration for training and naloxone kits. Design choices that reference the iconography, type, and form of materials associated with first aid have the potential to satisfy the need to de-stigmatize overdose response.
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Affiliation(s)
- Kate Sellen
- Health Design Studio, OCAD University, Toronto, ON, M5T 1W1, Canada.
| | - Benjamin Markowitz
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Janet A Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Curtis Handford
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Inner City Health Associates, Toronto, Canada
| | - Nick Goso
- Health Design Studio, OCAD University, Toronto, ON, M5T 1W1, Canada
| | | | - Michelle Klaiman
- Department of Emergency Medicine, St. Michael's Hospital, Unity Health, Toronto, Canada
| | | | | | - Amy Wright
- St. Michael's Hospital, Unity Health, Toronto, Canada
| | - Mercy Charles
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Laurie Morrison
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Carol Strike
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Aaron Orkin
- Inner City Health Associates, Toronto, Canada
- St. Michael's Hospital, Unity Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Emergency Medicine, St. Joseph's Health Centre, Unity Health, Toronto, Canada
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Kung A, Li DG, Lavery JA, Narang B, Diamond L. Characteristics of Cancer Hospitals with Written Language Access Policies. J Immigr Minor Health 2023; 25:282-290. [PMID: 36136231 PMCID: PMC10276971 DOI: 10.1007/s10903-022-01399-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/24/2022]
Abstract
Patients with limited English proficiency receive worse care due to communication barriers. Little is known about which cancer hospitals have written language access policies addressing bilingual clinicians. We conducted a cross-sectional survey of healthcare organizations, matching survey data to American Hospital Association Survey and American Community Survey data. We analyzed characteristics associated with hospitals having bilingual clinician policies. The response rate was 71% (127/178). Many hospitals (53 [42%]) did not have written policies on bilingual clinicians. Having bilingual clinicians available at the hospital was associated with having a written policy on bilingual clinicians, while being an NCORP site was associated with not having a written policy on bilingual clinicians. Patient demographic characteristics were not associated with hospitals having written policies on bilingual clinicians. A substantial proportion of cancer hospitals do not have policies that cover language use by bilingual clinicians, particularly at NCORP sites. Having written policies on bilingual clinicians has the potential to mitigate cancer disparities by facilitating accountability, improving communication, and reducing errors.
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Affiliation(s)
- Alina Kung
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Diane G Li
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bharat Narang
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lisa Diamond
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
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Kostareva U, Pe‘a (Varik) K, Siriwardhana C, Liu M, Qureshi K. Limited English Proficiency, Postoperative Complications, and Interpreter Use in Vascular Surgery Patients in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:39-49. [PMID: 36779005 PMCID: PMC9910193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A retrospective cohort analysis of inpatient and outpatient vascular surgery cases from 2014 to 2018 was conducted to analyze the relationship between limited English proficiency (LEP) and undesirable postoperative outcomes, and to evaluate interpreter use as part of culturally and linguistically appropriate services (CLAS). Propensity score matching and logistic regression models were used to examine the association of English proficiency with postoperative outcomes and chart review was done to examine CLAS provision. Of the 959 cases, 57 (6%) were LEP and had noticeably worse health status before surgery than non-LEP. The 57 cases include 51 patients who had a single vascular surgery and 3 patients who had 2 vascular surgeries (different medical encounter/visit). There was no statistically significant difference in postoperative outcomes between patients with LEP and without LEP. Males with LEP were significantly less likely than females to receive CLAS (P=.008). On the day of vascular surgery and/or the day informed surgical consent was obtained, 16% of patients with LEP received access to interpreters; 25% had no documentation about interpreter provision, and 59% had mixed language access (family, staff, or interpreter). The provision of interpreters might be influenced by providers' perceived ability to communicate with patients with LEP without an interpreter, ease of obtaining an interpreter, availability of family or ad-hoc interpreters, and patients' preferences. Future research should examine reasons for frequent use of untrained individuals and inform strategies to implement language services in line with national standards.
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Affiliation(s)
- Uliana Kostareva
- Nancy Atmospera-Walch School of Nursing (NAWSON), University of Hawai‘i at Manoa, Honolulu, HI (UK)
| | | | - Chathura Siriwardhana
- Biostatistics Core, John A. Burns School of Medicine, University of Hawai‘i at Manoa, Honolulu, HI (CS)
| | - Min Liu
- College of Education, University of Hawai‘i at Manoa, Honolulu, HI (ML)
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Imafuku R, Nagatani Y, Shoji M. Communication Management Processes of Dentists Providing Healthcare for Migrants with Limited Japanese Proficiency. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14672. [PMID: 36429391 PMCID: PMC9690798 DOI: 10.3390/ijerph192214672] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/06/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Low health literacy results in health inequity are linked with poor adherence to medical care. In the globalized Japanese context, the number of migrants with Japanese as a second language is increasing year after year. Since limited Japanese proficiency may pose a greater health risk, dentists are expected to manage cross-cultural communication and provide dental care to foreign patients. This study explored dentists' experiences of treating patients with limited Japanese proficiencies. Semi-structured interviews were conducted with 11 community dentists and the qualitative data were analyzed through a thematic analysis approach. Their major challenges were classified into three themes-linguistic aspect (e.g., complicated explanation regarding root canal treatment), sociolinguistic aspect (e.g., communication with foreign residents with limited dental knowledge), and sociocultural aspect (e.g., cultural differences in their dental aesthetics and insurance treatment system). Several management strategies were employed, including linguistic accommodation, avoidance of complexities, use of various communication tools, and getting help from others. However, they were unsatisfied with their practice because they could not understand the patients' psychosocial aspects due to incomplete communication. These findings provided insights into dentists' practice in the globalized context.
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Affiliation(s)
- Rintaro Imafuku
- Medical Education Development Center, Gifu University, Gifu 501-1194, Japan
| | - Yukiko Nagatani
- Department of Dental Hygiene, University of Shizuoka Junior College, Shizuoka 422-8021, Japan
| | - Masaki Shoji
- Department of Social and Administrative Pharmacy, Osaka Medical and Pharmaceutical University, Takatsuki 569-1094, Japan
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Conley CC, Rivera Rivera JN, Castro-Figueroa EM, Moreno L, Dutil J, García JD, Ricker C, Quinn GP, Soliman H, Vadaparampil ST. Provider discussion of genetic counseling among high-risk Spanish-preferring Latina breast cancer survivors. Transl Behav Med 2022; 12:900-908. [PMID: 36205471 PMCID: PMC9540969 DOI: 10.1093/tbm/ibac031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Among high-risk breast cancer (BC) survivors, genetic counseling (GC) and genetic testing (GT) may inform cascade testing and risk management. Compared to non-Hispanic White BC survivors, Spanish-preferring Latina BC survivors are less likely to report discussing GC with a healthcare provider. However, few studies have examined Latinas' experiences with GC/GT, particularly outside of the mainland USA. This study aimed to compare frequency of provider discussion of GC between Spanish-preferring Latina BC survivors living in Florida (FL) and Puerto Rico (PR). We conducted secondary data analysis of baseline assessments from a randomized pilot of an educational intervention for Spanish-preferring Latina BC survivors. Participants (N = 52) were GC/GT-naive, but met clinical criteria for GC/GT referral. Participants self-reported sociodemographic, clinical, and cultural variables, including previous provider discussion of GC. Descriptive statistics characterized frequency of GC discussion. Logistic regression examined the relationships between sociodemographic, clinical, and cultural characteristics and GC discussion. Only 31% of participants reported previous GC discussion. More participants from PR reported having GC discussions (43% vs. 21% in the mainland USA). In multivariable analyses, greater likelihood of GC discussion was associated with PR (vs. mainland USA) residence (odds ratio [OR] = 6.00, p = .03), older age at baseline (OR = 1.19, p = .04), and younger age at BC diagnosis (OR = 0.80, p = .03). Few high-risk Spanish-preferring Latina BC survivors in the mainland USA and PR had discussed GC with their providers. These results highlight a gap in the implementation of evidence-based genetics guidelines. Provider-directed interventions may be needed to increase uptake of GC/GT among Latina BC survivors.
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Affiliation(s)
- Claire C Conley
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA
| | | | | | | | - Julie Dutil
- Ponce Health Sciences University, Ponce 00716, Puerto Rico
| | | | - Charité Ricker
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA
| | - Gwendolyn P Quinn
- Grossman School of Medicine, New York University, New York, NY 10016, USA
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Soleimani J, Marquez A, Fathma S, Weister TJ, Barwise AK. Detecting professional interpreter use among patients with limited English proficiency: Derivation and validation study. SAGE Open Med 2022; 10:20503121221098146. [PMID: 35600712 PMCID: PMC9118401 DOI: 10.1177/20503121221098146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The objective of this derivation and validation study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services. Methods: We identified all adults who had at least one intensive care unit admission during their hospital stay across the Mayo Clinic Enterprise between 1 January 2015 and 30 June 2020. Three random subsets of 100 patients were extracted from 60,268 patients to develop the search strategy algorithm. Two physician reviewers conducted gold standard manual chart review and any discrepancies were resolved by a third reviewer. These results were compared with the search strategy algorithm each time it was refined. Sensitivity and specificity were calculated during each phase by comparing the search strategy results to the reference gold standard for both derivation cohorts and the final validation cohort. Results: The first search strategy resulted in a sensitivity of 100% and a specificity of 89%. The second revised search strategy achieved a sensitivity of 100% and a specificity of 87%. The final version of the search strategy was applied to the validation subset and sensitivity and specificity were 100% and 89%, respectively. Conclusion: We derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Using a search strategy algorithm with high sensitivity and specificity can reduce the time required to abstract data from the electronic medical records compared with manual data abstraction.
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Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Amelia Barwise, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Herzberg EM, Barrero-Castillero A, Matute JD. The healing power of language: caring for patients with limited english proficiency and COVID-19. Pediatr Res 2022; 91:526-528. [PMID: 33790416 PMCID: PMC8010487 DOI: 10.1038/s41390-021-01487-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Emily M. Herzberg
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA USA
| | - Alejandra Barrero-Castillero
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA USA ,grid.239395.70000 0000 9011 8547Division of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Juan D. Matute
- grid.32224.350000 0004 0386 9924Division of Neonatology and Newborn Medicine, Department of Pediatrics, Massachusetts General Hospital, Boston, MA USA
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Benda NC, Bisantz AM, Butler RL, Fairbanks RJ, Higginbotham J. The active role of interpreters in medical discourse - An observational study in emergency medicine. PATIENT EDUCATION AND COUNSELING 2022; 105:62-73. [PMID: 34052053 DOI: 10.1016/j.pec.2021.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/20/2021] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To study communicative tasks executed and related strategies used by patients, health professionals, and medical interpreters. METHODS English proficient and limited English proficient emergency department patients were observed. The content of patient-hospital staff communication was documented via pen and paper. Key themes and differences across interpreter types were established through qualitative analysis. Themes and differences across interpreter type were vetted and updated through member checking interviews. RESULTS 6 English proficient and 9 limited English proficient patients were observed. Key themes in communicative tasks included: establishing, maintaining, updating, and repairing understanding and rapport. All tasks were observed with English proficient and limited English proficient patients. The difference with limited English proficient patients was that medical interpreters played an active role in completing communicative tasks. Telephone-based interpreters faced challenges in facilitating communicative tasks based on thematic comparisons with in-person interpreters, including issues hearing and lost information due to the lack of visual cues. CONCLUSIONS Professional interpreters play an important role in communication between language discordant patients and health professionals that goes beyond verbatim translation. PRACTICAL IMPLICATIONS Training for interpreters and health professionals, and the design of tools for facilitating language discordant communication, should consider the role of interpreters beyond verbatim translation.
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Affiliation(s)
- Natalie C Benda
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA; MedStar Health National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA; Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61st St., Suite 301, New York 10065, NY, USA.
| | - Ann M Bisantz
- Department of Industrial and Systems Engineering, University at Buffalo, Buffalo, NY, USA
| | - Rebecca L Butler
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA; MedStar Quality and Safety, MedStar Health, Columbia, MD, USA
| | - Rollin J Fairbanks
- MedStar Health National Center for Human Factors in Healthcare, MedStar Health, Washington, DC, USA; MedStar Quality and Safety, MedStar Health, Columbia, MD, USA
| | - Jeff Higginbotham
- Department of Communicative Disorders and Sciences, Buffalo, NY, USA
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Chang H, Hutchinson C, Gullick J. Pulled away: the experience of bilingual nurses as ad hoc interpreters in the emergency department. ETHNICITY & HEALTH 2021; 26:1045-1064. [PMID: 31046427 DOI: 10.1080/13557858.2019.1613518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/24/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to understand the experiences of bilingual nurses asked to interpret in the Emergency Department (ED), and the subsequent impact on safety climate. Australian ED clinicians assess and treat high numbers of linguistically diverse patients, many with limited English proficiency. New South Wales Health policy mandates the use of accredited interpreters when collecting personal and health information, and when obtaining consent for medical procedures. Semi-structured interviews with 12 nurses (representing 12 languages) from two metropolitan EDs were audio-recorded and analysed using qualitative content analysis, guided by Glendon & Stanton's model of organisational climate and culture. Analysis revealed widespread underlying assumptions that engaging interpreters is difficult, time-consuming and costly. Bilingual ED nurses with variable language fluency were used across organisations as the first choice due to clinical urgency, task urgency, and hospital workflow pressures. While the use of nurse interpreters facilitated timely assessment for the benefit of patients, it equally led to increased nurse workload, missed or misinterpreted information and subsequent perceived clinical risk. These practices were supported and facilitated by unit level managerial and multidisciplinary team practices, physician pressure and the nurses' own values and beliefs. While some, (but not all) participants were aware of the interpreter policy, they were torn between their acknowledgement of risky translation practices and their desire to support their colleagues to provide timely, culturally-competent assessment and care. Findings suggests a 'top-down' approach to translation policy has failed to influence the local safety culture and practices and does not address a climate created by clinical urgency and workflow. Formal training and accreditation of bilingual nurses, and/or embedded interpreters for common language groups may reduce risks for non-English speaking patients.
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Affiliation(s)
- Heesun Chang
- Emergency Department, Concord Repatriation General Hospital, Concord West, NSW, Australia
| | - Claire Hutchinson
- Emergency Department, The Canterbury Hospital, Campsie, NSW, Australia
| | - Janice Gullick
- Susan Wakil School of Nursing & Midwifery, University of Sydney, Camperdown, NSW, Australia
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Pandey M, Maina RG, Amoyaw J, Li Y, Kamrul R, Michaels CR, Maroof R. Impacts of English language proficiency on healthcare access, use, and outcomes among immigrants: a qualitative study. BMC Health Serv Res 2021; 21:741. [PMID: 34311712 PMCID: PMC8314461 DOI: 10.1186/s12913-021-06750-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Immigrants from culturally, ethnically, and linguistically diverse countries face many challenges during the resettlement phase, which influence their access to healthcare services and health outcomes. The "Healthy Immigrant Effect" or the health advantage that immigrants arrive with is observed to deteriorate with increased length of stay in the host country. METHODS An exploratory qualitative design, following a community-based research approach, was employed. The research team consisted of health researchers, clinicians, and community members. The objective was to explore the barriers to healthcare access among immigrants with limited English language proficiency. Three focus groups were carried out with 29 women and nine men attending English language classes at a settlement agency in a mid-sized city. Additionally, 17 individual interviews were carried out with healthcare providers and administrative staff caring for immigrants and refugees. RESULTS A thematic analysis was carried out with transcribed focus groups and healthcare provider interview data. Both the healthcare providers and immigrants indicated that limited language proficiency often delayed access to available healthcare services and interfered with the development of a therapeutic relationship between the client and the healthcare provider. Language barriers also impeded effective communication between healthcare providers and clients, leading to suboptimal care and dissatisfaction with the care received. Language barriers interfered with treatment adherence and the use of preventative and screening services, further delaying access to timely care, causing poor chronic disease management, and ultimately resulting in poor health outcomes. Involving untrained interpreters, family members, or others from the ethnic community was problematic due to misinterpretation and confidentiality issues. CONCLUSIONS The study emphasises the need to provide language assistance during medical consultations to address language barriers among immigrants. The development of guidelines for recruitment, training, and effective engagement of language interpreters during medical consultation is recommended to ensure high quality, equitable and client-centered care.
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Affiliation(s)
- Mamata Pandey
- Research Department, Wascana Rehabilitation Centre, Saskatchewan Health Authority, 2180-23rd Ave, Regina, SK, S4S 0A5, Canada.
| | - R Geoffrey Maina
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Jonathan Amoyaw
- Department of Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
| | - Yiyan Li
- College of Nursing, University of Saskatchewan, Prince Albert, SK, Canada
| | - Rejina Kamrul
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - C Rocha Michaels
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
| | - Razawa Maroof
- Department of Academic Family Medicine, University of Saskatchewan, Regina, SK, Canada
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Blackwell L, Gower NT, Patel R. Experiences of language barriers by homoeopathy student interns providing health services at the University of Johannesburg. Health SA 2021; 26:1491. [PMID: 33936785 PMCID: PMC8063548 DOI: 10.4102/hsag.v26i0.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 02/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background South Africa is a multilingual society, and therefore, the likelihood of healthcare providers (HCPs), including students training to be HCPs, encountering language barriers with patients is high. Aim To explore and describe the experiences of homoeopathy student interns regarding language barriers in the delivery of health services and to provide guidance towards overcoming language barriers in homoeopathic practice at the University of Johannesburg (UJ). Setting The interviews and focus group discussions were conducted in English and at a private location that was convenient for the participants in Johannesburg, Gauteng. Methods This qualitative study used a phenomenological approach. Ten individual interviews were conducted with registered homoeopathy student interns (HSIs) from the UJ. The central question: ‘What has your experience been regarding language barriers between you and your patients at the UJ Homoeopathy clinics?’ was asked and responses were recorded and transcribed for later analysis. The interview results were presented to a focus group for discussion to validate findings that arose from the analysis and to provide an opportunity to add any insight, comment or recommendations that were not expressed in individual interviews and verification of emergent themes. Results Participants described how language barriers create challenges in understanding between patients and HSIs. Descriptions of the experiences of the intrapersonal and interpersonal effects that are associated with language barriers were provided. Participants also described the influence of language barriers on the various aspects of the health service process. Finally, participants described the mitigation of language barriers through various strategies. Conclusion Participants reported their experiences of language barriers as challenging. Language barriers were found to adversely affect the various aspects of the health service process as well as the practitioner’s personal feelings and the patient–practitioner relationship. Language acquisition and awareness modules introduced early on in the syllabus is a proposed solution to the mitigation of language barriers.
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Affiliation(s)
- Lorna Blackwell
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Neil T Gower
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Reshma Patel
- Department of Complementary Medicine, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
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Jafar AJN. Advocating for those who need it most: our responsibility for delivering appropriate care to refugee and asylum seeking patients. Emerg Med J 2020; 38:3-4. [PMID: 33214198 DOI: 10.1136/emermed-2020-210800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 11/03/2022]
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Carvajal Bedoya G, Davis LA, Hirsh JM. Patient-Reported Outcomes in Rheumatology Patients With Limited English Proficiency and Limited Health Literacy. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:738-749. [PMID: 33091257 DOI: 10.1002/acr.24243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
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Feiring E, Westdahl S. Factors influencing the use of video interpretation compared to in-person interpretation in hospitals: a qualitative study. BMC Health Serv Res 2020; 20:856. [PMID: 32917206 PMCID: PMC7488494 DOI: 10.1186/s12913-020-05720-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Facilitating access to professional interpretation services is key to equitable hospital care for migrants with limited language proficiency; however, interpreter underuse has been documented. The factors that potentially enable or hinder professional interpreter use are not well understood. We aimed to compare perceptions held by hospital managers and healthcare practitioners of the factors influencing the use of remote video interpretation and in-person interpretation. METHODS This study employed a retrospective qualitative design. Two hospitals, located in Austria and Norway, with adequately similar baseline characteristics were purposively selected. Both hospitals used in-person interpreters, and the Austrian hospital had recently introduced remote video interpretation as an alternative and supplement. Fifteen managers and healthcare practitioners participated in focus groups and individual interviews. Data were thematically analysed with the aid of behavioural system theory. RESULTS Across sites, the facilitators of interpreter use included individual factors (knowledge about interpreter services, skills to assess when/how to use an interpreter, beliefs about favourable consequences), as well as organisational factors (soft budget constraints). Barriers were identified at the individual level (lack of interpersonal skills to handle difficult provider-interpreter situations, lack of skills to persuade patients to accept interpreter use, lack of trust in service professionalism), and at the organisational level (limited interpreter availability, time constraints). The introduction of remote video interpretation services seemed to counteract the organisational barriers. Video interpretation was further perceived to enable patient confidentiality, which was regarded as a facilitator. However, video interpretation introduced specific barriers, including perceived communication deficiencies. CONCLUSION This study has identified a range of factors that are perceived to influence the use of interpreters in hospitals. The research suggests that-implementing remote video interpretation services lessens the barriers to use and that such services should be introduced in hospital settings as an alternative or supplement to in-person interpreters. Further intervention functions should be considered to bring about change in the use of interpretation services, including developing guidelines for interpreter use, educating staff in the appropriate use of video technology, and training staff in communicating with interpreter and patients with limited language proficiency.
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Affiliation(s)
- Eli Feiring
- Department of Health Management and Health Economics, University of Oslo, PO Box 1089, Blindern, 0317, Oslo, Norway.
| | - Stine Westdahl
- Department of Health Management and Health Economics, University of Oslo, PO Box 1089, Blindern, 0317, Oslo, Norway
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Paredes AZ, Aquina CT, Selby LV, DiFilippo S, Pawlik TM. Increasing Importance of Ethics in Surgical Decision Making. Adv Surg 2020; 54:251-263. [PMID: 32713434 DOI: 10.1016/j.yasu.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anghela Z Paredes
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH 43210, USA
| | - Christopher T Aquina
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH 43210, USA
| | - Luke V Selby
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH 43210, USA
| | - Stephanie DiFilippo
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH 43210, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, Suite 670, Columbus, OH 43210, USA.
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Mirza M, Harrison EA, Roman M, Miller KA, Jacobs EA. Walking the talk: understanding how language barriers affect the delivery of rehabilitation services. Disabil Rehabil 2020; 44:301-314. [DOI: 10.1080/09638288.2020.1767219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth A. Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marissa Roman
- Rehabilitation Sciences Program, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathryn A. Miller
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Elizabeth A. Jacobs
- Departments of Population Health and Internal Medicine, University of Texas, Austin, TX, USA
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Phillips KA, Singh Ospina N, Montori V. Physicians Interrupting Patients. J Gen Intern Med 2019; 34:1963. [PMID: 31289991 PMCID: PMC6816612 DOI: 10.1007/s11606-019-05141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kari A Phillips
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Victor Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Yelland J, Biro MA, Dawson W, Riggs E, Vanpraag D, Wigg K, Antonopoulos J, Morgans J, Szwarc J, East C, Brown S. Bridging the language gap: a co-designed quality improvement project to engage professional interpreters for women during labour. AUST HEALTH REV 2019; 41:499-504. [PMID: 27568077 DOI: 10.1071/ah16066] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/20/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the study was to improve the engagement of professional interpreters for women during labour. Methods The quality improvement initiative was co-designed by a multidisciplinary group at one Melbourne hospital and implemented in the birth suite using the plan-do-study-act framework. The initiative of offering women an interpreter early in labour was modified over cycles of implementation and scaled up based on feedback from midwives and language services data. Results The engagement of interpreters for women identified as requiring one increased from 28% (21/74) at baseline to 62% (45/72) at the 9th month of implementation. Conclusion Improving interpreter use in high-intensity hospital birth suites is possible with supportive leadership, multidisciplinary co-design and within a framework of quality improvement cycles of change. What is known about the topic? Despite Australian healthcare standards and policies stipulating the use of accredited interpreters where needed, studies indicate that services fall well short of meeting these during critical stages of childbirth. What does the paper add? Collaborative approaches to quality improvement in hospitals can significantly improve the engagement of interpreters to facilitate communication between health professionals and women with low English proficiency. What are the implications for practice? This language services initiative has potential for replication in services committed to improving effective communication between health professionals and patients.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia. ;
| | - Mary Anne Biro
- School of Nursing and Midwifery, Monash University, Wellington & Blackburn Roads, Clayton, Vic., 3800, Australia.
| | - Wendy Dawson
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia. ;
| | - Elisha Riggs
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia. ;
| | - Dannielle Vanpraag
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia. ;
| | - Karen Wigg
- Monash Women's, Monash Health, David Street, Dandenong, Vic. 3175, Australia.
| | - John Antonopoulos
- Community and Allied Health, Monash Health, 135 David Street, Dandenong, Vic. 3175, Australia. Email
| | - Jenny Morgans
- Monash Women's, Monash Health, David Street, Dandenong, Vic. 3175, Australia.
| | - Jo Szwarc
- Victorian Foundation for Survivors of Torture, 6 Gardiner Street, Brunswick, Vic. 3056, Australia. Email
| | - Chris East
- School of Nursing and Midwifery, Monash University, Wellington & Blackburn Roads, Clayton, Vic., 3800, Australia.
| | - Stephanie Brown
- Healthy Mothers Healthy Families Research Group, Murdoch Childrens Research Institute, 50 Flemington Road, Parkville, Vic. 3052, Australia. ;
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Abstract
BACKGROUND Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non-ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge. AIM We studied adherence to guidelines for NSTEMI in the ED. METHODS A single-center, retrospective study of consecutive patients with NSTEMI admitted to a tertiary hospital and discharged alive between March 2013 and March 2014. ED records were manually reviewed for adherence to prespecified parameters. Cases with sudden death, shock, or type-II NSTEMI were excluded. Canadian Triage and Acuity Scale score system was used for triage in the ED. RESULTS Adherence rates were 33.3%/24.6% of 240 patients for ECG/troponin obtained within 10/60 minutes receptively and 31.3% for anticoagulation within 15 minutes from diagnosis of ACS. Females were less likely to undergo electrocardiography (P = 0.009) or troponin-level tests within the specified timeframe (P = 0.043). Many cardiovascular risk markers were missed. Global Registry of Acute Coronary Events score was not used to risk stratify patients. CONCLUSIONS Prompt identification and early medical treatment of NSTEMI in the ED is lacking. Better computerized medical history assembly, attention to typical and atypical clinical presentation, and the employment of an appropriate cardiologic risk stratification method may unblind the treating teams at the point of care and improve adherence to NSTEMI guidelines.
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Abbato S, Ryan J, Skelly C, Good P. The other side of “getting by”: A case study of interpreting provision decision-making and consequences for patients. COGENT MEDICINE 2018. [DOI: 10.1080/2331205x.2018.1483096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
| | | | - Chris Skelly
- Head of Programmes (Research and Intelligence), Public Health Dorset, Dorset, UK
| | - Phillip Good
- Mater Health Services, Mater Research Institute-University of Queensland, St Vincent’s Private Hospital, Brisbane, Queensland, Australia
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Njeru JW, Boehm DH, Jacobson DJ, Guzman-Corrales LM, Fan C, Shimotsu S, Wieland ML. Diabetes Outcome and Process Measures Among Patients Who Require Language Interpreter Services in Minnesota Primary Care Practices. J Community Health 2018; 42:819-825. [PMID: 28229264 DOI: 10.1007/s10900-017-0323-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Immigrants and refugees are less likely to meet diabetes management goals than the general US population. Those with limited English proficiency (LEP) and who need interpreter services (IS) for health care encounters, maybe at higher risk for encountering barriers to optimal diabetes management, and while most receive diabetes care in primary care settings, little is known about the association between IS need and diabetes outcomes. This study aims to determine adherence with diabetes process and outcomes measures among LEP patients in primary care settings, and is a retrospective cohort study of patients with type II diabetes at two large primary care networks in Minnesota from January 1, 2012 through December 31, 2013. Diabetes outcome measure goals were defined as hemoglobin A1C <8%, LDL-C <100 mg/dL, and blood pressure <140/90 mmHg. Process measure goals were defined as hemoglobin A1C measured within the previous 6 months and LDL cholesterol (LDL-C) measured within the previous 12 months. Compared to non-IS patients (N = 11,970), IS patients (N = 1486) were more likely to meet guideline outcome recommendations for blood pressure (Adjusted odds ratio [OR] 2.02; 95% confidence interval [CI] 1.70, 2.40), hemoglobin A1C (OR 1.23; 95% CI 1.08, 1.40), and LDL-C (OR 1.40; 95% CI 1.2, 1.62). Older IS patients and male IS patients were less likely to meet recommendations for hemoglobin A1C (OR 0.70; 95% CI 0.48, 1.02; OR 0.66; CI 0.54, 0.79; respectively) and LDL-C (OR 0.81; 95% CI 0.55, 1.17; OR 0.47; CI 0.39, 0.57; respectively). Healthcare system solutions need to bridge gaps from process to outcomes among LEP patients who require IS in primary care settings.
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Affiliation(s)
- Jane W Njeru
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Deborah H Boehm
- Hennepin County Medical Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Laura M Guzman-Corrales
- Hennepin County Medical Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Scott Shimotsu
- Analytics Center of Excellence, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Mark L Wieland
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Estrada RD, Messias DKH. Language Co-Construction and Collaboration in Interpreter-Mediated Primary Care Encounters With Hispanic Adults. J Transcult Nurs 2018; 29:498-505. [PMID: 29308730 DOI: 10.1177/1043659617747523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Language asymmetry between patients and providers may influence the context, content, and quality of health care communication, affecting patient outcomes and contributing to health disparities. This research examined interpreter-mediated, primary care encounters between English-speaking nurse practitioners and Spanish-speaking adult patients. METHOD Situational analysis guided the collection, analysis, and interpretation of audio-recorded clinical encounter data. RESULTS Interpreter-mediated communication was situated within intersecting social, economic, political, and health systems contexts. Three modes of collaborative knowledge generations were Constructing Connections, Constructing Mutual Understanding, and Constructing Effective Systems Navigation Strategies. DISCUSSION These findings illustrate how interactants contributed individual and collective knowledge across multiple systems to address patient concerns. CONCLUSION The analysis revealed ways in which communication processes may influence both providers' diagnostic and interventional decision-making and patients' understanding and potential compliance. Ongoing preparation and support for intraprofessional collaboration is needed to ensure effective communication and mitigate untoward effects of language asymmetries in clinical encounters.
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Affiliation(s)
| | - DeAnne K Hilfinger Messias
- 1 University of South Carolina, Columbia, SC, USA.,2 Women's and Gender Studies Program, University of South Carolina, Columbia, SC, USA
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Teunissen E, Gravenhorst K, Dowrick C, Van Weel-Baumgarten E, Van den Driessen Mareeuw F, de Brún T, Burns N, Lionis C, Mair FS, O'Donnell C, O'Reilly-de Brún M, Papadakaki M, Saridaki A, Spiegel W, Van Weel C, Van den Muijsenbergh M, MacFarlane A. Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study. Int J Equity Health 2017; 16:32. [PMID: 28222736 PMCID: PMC5320766 DOI: 10.1186/s12939-017-0525-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 01/23/2017] [Indexed: 12/03/2022] Open
Abstract
Background Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. Methods We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers’ fieldwork reports, were coded and thematically analysed by each team using NPT. Results In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants’ needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP’s diagnoses and GPs reported a clearer understanding of migrants’ symptoms. Conclusions Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.
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Affiliation(s)
- E Teunissen
- Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, the Netherlands
| | - K Gravenhorst
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, United Kingdom
| | - C Dowrick
- Department of Psychological Sciences, B121 Waterhouse Buildings University of Liverpool, Liverpool, United Kingdom
| | - E Van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Medical Center, NIjmegen, the Netherlands
| | | | - T de Brún
- Discipline of General Practice, School of Medicine, National University ofIreland, Galway, Ireland
| | - N Burns
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK and General Practice & Primary Care, Institute of Health & Wellbeing, College of MVLS, University of Glasgow, Glasgow, UK
| | - C Lionis
- Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece
| | - F S Mair
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - C O'Donnell
- General Practice & Primary Care, Institute of Health and Wellbeing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - M O'Reilly-de Brún
- Discipline of General Practice, School of Medicine, National University ofIreland, Galway, Ireland
| | - M Papadakaki
- Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece.,Department of Social Work, School of Health and Social Welfare Technological Educational Institute of Crete Heraklion, Crete, Greece
| | - A Saridaki
- Clinic of Social and Family Medicine, University of Crete Medical School, Crete, Greece
| | - W Spiegel
- Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, A-1090, Vienna, Austria
| | - C Van Weel
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.,Australian Primary Health Care Research Institute, Nijmegen, the Netherlands
| | - M Van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands. .,Pharos, Centre of Expertise for Health Disparities, Utrecht, the Netherlands.
| | - A MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Ryan J, Abbato S, Greer R, Vayne-Bossert P, Good P. Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2017; 54:46958017739981. [PMID: 29144184 PMCID: PMC5798672 DOI: 10.1177/0046958017739981] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 09/17/2017] [Accepted: 09/21/2017] [Indexed: 12/04/2022]
Abstract
The provision of professional interpreting services in the hospital setting decreases communication errors of clinical significance and improves clinical outcomes. A retrospective audit was conducted at a tertiary referral adult hospital in Brisbane, Australia. Of 20 563 admissions of patients presenting to the hospital emergency department (ED) and admitted to a ward during 2013-2014, 582 (2.8%) were identified as requiring interpreting services. In all, 19.8% of admissions were provided professional interpreting services in the ED, and 26.1% were provided on the ward. Patients were more likely to receive interpreting services in the ED if they were younger, spoke an Asian language, or used sign language. On the wards, using sign language was associated with 3 times odds of being provided an interpreter compared with other languages spoken. Characteristics of patients including their age and type of language spoken influence the clinician's decision to engage a professional interpreter in both the ED and inpatient ward.
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Affiliation(s)
- Jennifer Ryan
- Mater Health Services, South Brisbane, Queensland, Australia
| | | | - Ristan Greer
- G&R Greer Pty Ltd T/A Torus Research, Brisbane, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
| | - Petra Vayne-Bossert
- Mater Health Services, South Brisbane, Queensland, Australia
- University Hospitals of Geneva, Switzerland
| | - Phillip Good
- Mater Health Services, South Brisbane, Queensland, Australia
- Mater Research Institute - The University of Queensland, Brisbane, Australia
- St Vincent’s Private Hospital Brisbane, Queensland, Australia
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Cramer E. The Impact of Professional Language Interpreting in Midwifery Care: A Review of the Evidence. INTERNATIONAL JOURNAL OF CHILDBIRTH 2017. [DOI: 10.1891/2156-5287.7.1.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: Patients’ limited proficiency in the language of health care providers is known to be associated with health care disparities. Reluctance to use professional interpreting is documented across a wide range of health care professionals. Most of the literature on the effect of interpreting practices has focused on non-midwifery contexts.OBJECTIVE: To review the evidence regarding how using professional interpreters impacts the midwifery care of women with limited dominant language proficiency (LDLP).METHODS: Eligible studies were identified using searches of MEDLINE, CINAHL, and Maternity and Infant Care, then analyzed and assessed for applicability to midwifery.RESULTS: 40 eligible papers, and two systematic reviews containing 48 additional papers, were included. The use of professional interpreters was found to support all aspects of the midwife’s direct role, with some complex findings on woman-centered communication during interpreted encounters. The use of ad hoc interpreters, or no interpreting, undermines all aspects of midwifery care for women with LDLP.IMPLICATIONS: Midwifery care should be enhanced by increasing midwives’ use of professional interpreters; future research should consider how best to achieve this or investigate the comparative efficacy of more complex interventions, such as interpreter-doulas.
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Lindenmeyer A, Redwood S, Griffith L, Teladia Z, Phillimore J. Experiences of primary care professionals providing healthcare to recently arrived migrants: a qualitative study. BMJ Open 2016; 6:e012561. [PMID: 27660320 PMCID: PMC5051449 DOI: 10.1136/bmjopen-2016-012561] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The main objectives of the study were to explore the experiences of primary care professionals providing care to recent migrants in a superdiverse city and to elicit barriers and facilitators to meeting migrants' care needs. This paper focuses on a strong emergent theme: participants' descriptions and understandings of creating a fit between patients and practices. DESIGN An exploratory, qualitative study based on the thematic analysis of semistructured interviews. SETTING AND PARTICIPANTS A purposive sample of 10 practices. We interviewed 6 general practitioners, 5 nurses and 6 administrative staff; those based at the same practice opted to be interviewed together. 10 interviewees were from an ethnic minority background; some discussed their own experiences of migration. RESULTS Creating a fit between patients and practice was complex and could be problematic. Some participants defined this in a positive way (reaching out, creating rapport) while others also focused on ways in which patients did not fit in, for example, different expectations or lack of medical records. A small but vocal minority put the responsibility to fit in on to migrant patients. Some participants believed that practice staff and patients sharing a language could contribute to achieving a fit but others outlined the disadvantages of over-reliance on language concordance. A clearly articulated, team-based strategy to create bridges between practice and patients was often seen as preferable. CONCLUSIONS Although participants agreed that a fit between patients and practice was desirable, some aimed to adapt to the needs of recently arrived migrants, while others thought that it was the responsibility of migrants to adapt to practice needs; a few viewed migrant patients as a burden to the system. Practices wishing to improve fit might consider developing strategies such as introducing link workers and other 'bridging' people; however, they could also aim to foster a general stance of openness to diversity.
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Affiliation(s)
- Antje Lindenmeyer
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sabi Redwood
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Laura Griffith
- Health Services Management Centre, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Zaheera Teladia
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jenny Phillimore
- Institute of Research into Superdiversity, College of Social Sciences, University of Birmingham, Birmingham, UK
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Burt J, Abel G, Elmore N, Lloyd C, Benson J, Sarson L, Carluccio A, Campbell J, Elliott MN, Roland M. Understanding negative feedback from South Asian patients: an experimental vignette study. BMJ Open 2016; 6:e011256. [PMID: 27609844 PMCID: PMC5020840 DOI: 10.1136/bmjopen-2016-011256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In many countries, minority ethnic groups report poorer care in patient surveys. This could be because they get worse care or because they respond differently to such surveys. We conducted an experiment to determine whether South Asian people in England rate simulated GP consultations the same or differently from White British people. If these groups rate consultations similarly when viewing identical simulated consultations, it would be more likely that the lower scores reported by minority ethnic groups in real surveys reflect real differences in quality of care. DESIGN Experimental vignette study. Trained fieldworkers completed computer-assisted personal interviews during which participants rated 3 video recordings of simulated GP-patient consultations, using 5 communication items from the English GP Patient Survey. Consultations were shown in a random order, selected from a pool of 16. SETTING Geographically confined areas of ∼130 households (output areas) in England, selected using proportional systematic sampling. PARTICIPANTS 564 White British and 564 Pakistani adults recruited using an in-home face-to-face approach. MAIN OUTCOME MEASURE Mean differences in communication score (on a scale of 0-100) between White British and Pakistani participants, estimated from linear regression. RESULTS Pakistani participants, on average, scored consultations 9.8 points higher than White British participants (95% CI 8.0 to 11.7, p<0.001) when viewing the same consultations. When adjusted for age, gender, deprivation, self-rated health and video, the difference increased to 11.0 points (95% CI 8.5 to 13.6, p<0.001). The largest differences were seen when participants were older (>55) and where communication was scripted to be poor. CONCLUSIONS Substantial differences in ratings were found between groups, with Pakistani respondents giving higher scores than White British respondents to videos showing the same care. Our findings suggest that the lower scores reported by Pakistani patients in national surveys represent genuinely worse experiences of communication compared to the White British majority.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Gary Abel
- University of Exeter Medical School, Exeter, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Lionis C, Papadakaki M, Saridaki A, Dowrick C, O'Donnell CA, Mair FS, van den Muijsenbergh M, Burns N, de Brún T, O'Reilly de Brún M, van Weel-Baumgarten E, Spiegel W, MacFarlane A. Engaging migrants and other stakeholders to improve communication in cross-cultural consultation in primary care: a theoretically informed participatory study. BMJ Open 2016; 6:e010822. [PMID: 27449890 PMCID: PMC4964217 DOI: 10.1136/bmjopen-2015-010822] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings. SETTING As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands. PARTICIPANTS A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners). PRIMARY AND SECONDARY OUTCOME MEASURES We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs. RESULTS The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project. CONCLUSIONS This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants.
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Affiliation(s)
| | - Maria Papadakaki
- Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece
| | | | - Christopher Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Catherine A O'Donnell
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Frances S Mair
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
- Pharos Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Nicola Burns
- Department of General Practice and Primary Care, Institute of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow
- Faculty of Health and Medicine, Lancaster Medical School, Furness College, University of Lancaster, Lancaster University, Lancaster, UK
| | - Tomas de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Mary O'Reilly de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | | | - Wolfgang Spiegel
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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Hirsh JM. The Challenge and Opportunity of Capturing Patient Reported Measures of Rheumatoid Arthritis Disease Activity in Vulnerable Populations with Limited Health Literacy and Limited English Proficiency. Rheum Dis Clin North Am 2016; 42:347-62. [DOI: 10.1016/j.rdc.2016.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey. Br J Gen Pract 2015; 66:e47-52. [PMID: 26541182 PMCID: PMC4684035 DOI: 10.3399/bjgp15x687637] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/22/2015] [Indexed: 11/03/2022] Open
Abstract
Background Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. Aim To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender. Design and setting Analysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders. Method A composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. Results There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’. Conclusion The identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.
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Innes K, Jackson D, Plummer V, Elliott D. Care of patients in emergency department waiting rooms - an integrative review. J Adv Nurs 2015; 71:2702-14. [DOI: 10.1111/jan.12719] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Kelli Innes
- Faculty of Health; University of Technology Sydney; New South Wales Australia
- Faculty of Medicine, Nursing and Health Sciences; School of Nursing and Midwifery; Monash University; Frankston Victoria Australia
| | - Debra Jackson
- Faculty of Health; University of Technology Sydney; New South Wales Australia
| | - Virginia Plummer
- Faculty of Medicine, Nursing and Health Sciences; School of Nursing and Midwifery; Monash University; Frankston Victoria Australia
| | - Doug Elliott
- Faculty of Health; University of Technology Sydney; New South Wales Australia
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Yelland J, Riggs E, Szwarc J, Casey S, Duell-Piening P, Chesters D, Wahidi S, Fouladi F, Brown S. Compromised communication: a qualitative study exploring Afghan families and health professionals' experience of interpreting support in Australian maternity care. BMJ Qual Saf 2015; 25:e1. [PMID: 26089208 DOI: 10.1136/bmjqs-2014-003837] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/30/2015] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Difficulties associated with communication are thought to contribute to adverse perinatal outcomes experienced by refugee background women living in developed countries. This study explored Afghan women and men's experience of language support during pregnancy, labour and birth, and health professionals' experiences of communicating with clients of refugee background with low English proficiency. METHODS Interviews were conducted with (1) Afghan women and men in the first year after having a baby in Australia, by multilingual, bicultural researchers and (2) midwives and medical practitioners providing care to families of refugee background. Analysis was conducted thematically. RESULTS Sixteen Afghan women, 14 Afghan men, 10 midwives, five medical practitioners and 19 community-based health professionals (refugee health nurses, bicultural workers, counsellors) providing maternity or early postnatal care participated. Midwife and medical informants concurred that accredited interpreters are generally booked for the first pregnancy visit, but not routinely used for other appointments. Very few Afghan participants reported access to on-site interpreters. Men commonly interpreted for their wives. There was minimal professional interpreting support for imaging and pathology screening appointments or during labour and birth. Health professionals noted challenges in negotiating interpreting services when men were insistent on providing language support for their wives and difficulties in managing interpreter-mediated visits within standard appointment times. Failure to engage interpreters was apparent even when accredited interpreters were available and at no cost to the client or provider. CONCLUSIONS Improving identification of language needs at point of entry into healthcare, developing innovative ways to engage interpreters as integral members of multidisciplinary healthcare teams and building health professionals' capacity to respond to language needs are critical to reducing social inequalities in maternal and child health outcomes for refugee and other migrant populations.
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Affiliation(s)
- Jane Yelland
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Elisha Riggs
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Josef Szwarc
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Sue Casey
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | | | - Donna Chesters
- Victorian Foundation for Survivors of Torture, Brunswick, Victoria, Australia
| | - Sayed Wahidi
- Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Fatema Fouladi
- Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Brown
- Healthy Mothers Healthy Families, Murdoch Childrens Research Institute, Parkville, Victoria, Australia Department of General Practice and Primary Health Care, University of Melbourne, Parkville, Victoria, Australia School of Population Health, University of Melbourne, Parkville, Victoria, Australia
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Yu S, Lin S, Strickland B. Disparities in Health Care Quality Indicators among US Children with Special Health Care Needs According to Household Language Use. Int J MCH AIDS 2015; 4:3-12. [PMID: 27621998 PMCID: PMC4948155 DOI: 10.21106/ijma.51] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Lower health care utilization and less favorable health outcomes have been demonstrated in children from Non-English Primary Language households (NEPL) in previous studies. This study examines prevalence of health care quality indicators among US children with special health care needs (CSHCN) and their association with household language use. METHODS We used data from the 2009-2010 National Survey of Children with Special Health Care Needs, restricted to an analytic sample of 40,242 children. Logistic regression models were used to examine the effects of primary household language on the attainment of the 6 health care quality indicators for CSHCN. RESULTS Compared to CSHCN from English primary language households (EPL), CSHCN from NEPL households had 31% higher odds of not feeling like partners in health care decision-making. They had 67% higher odds of lacking care through a medical home and 42% higher odds of reporting inadequate health insurance. NEPL children had 32% higher odds of not receiving early and continuous screening for special health care needs. NEPL youths had 69% higher odds of not receiving services for transition to adulthood. Minority race/ethnicity, lower income and families other than two biological parents all conferred additional risks to not attaining quality indicators. Publicly insured or uninsured CSHCN were also at higher risk. CONCLUSIONS AND GLOBAL HEALTH IMPLICATIONS Our study provides compelling evidence that significant disparities exist for CSHCN by primary household language status across all health care quality indicators. Establishment of effective surveillance systems and targeting of outreach programs in both developed and developing countries may lead to improved understanding of health care needs and quality of services and reduction of health disparities for this underserved population.
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Affiliation(s)
- Stella Yu
- The Center for Global Health and Health Policy, Global Health and Education Projects, Inc., Riverdale, MD 20738, USA
| | - Sue Lin
- US Department of Health and Human Services, Health Resources and Services Administration, Bureau of Primary Health Care, Rockville, MD 20857, USA
| | - Bonnie Strickland
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD 20857, USA
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Hsieh E. Not just "getting by": factors influencing providers' choice of interpreters. J Gen Intern Med 2015; 30:75-82. [PMID: 25338731 PMCID: PMC4284281 DOI: 10.1007/s11606-014-3066-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/08/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Providers consistently underutilize professional interpreters in healthcare settings even when they perceive benefits to using professional interpreters and when professional interpreters are readily available. Little is known about providers' decision-making processes that shape their use of interpreters. OBJECTIVE To understand the variety of considerations and parameters that influence providers' decisions regarding interpreters. DESIGN A qualitative, semi-structured interview guide was used to explore providers' decision making about interpreter use. The author conducted 8 specialty-specific focus groups and 14 individual interviews, each lasting 60-90 minutes. PARTICIPANTS Thirty-nine healthcare professionals were recruited from five specialties (i.e., nursing, mental health, emergency medicine, oncology, and obstetrics-gynecology) in a large academic medical center characterized as having "excellent" interpreter services. APPROACH Audio-recorded interviews and focus groups were transcribed and analyzed using grounded theory to develop a theoretical framework for providers' decision-making processes. KEY RESULTS Four factors influence providers' choice of interpreters: (a) time constraints, (b) alliances of care, (c) therapeutic objectives, and (d) organizational-level considerations. The findings highlight (a) providers' calculated use of interpreters and interpreting modalities, (b) the complexity of the functions and impacts of time in providers' decision-making process, and (c) the importance of organizational structures and support for appropriate and effective interpreter utilization. CONCLUSIONS Providers actively engage in calculated use of professional interpreters, employing specific factors in their decision-making processes. Providers' understanding of time is complex and multidimensional, including concerns about disruptions to their schedules, overburdening others' workloads, and clinical urgency of patient condition, among others. When providers make specific choices due to time pressure, they are influenced by interpersonal, organizational, therapeutic, and ethical considerations. Organizational resources and guidelines need to be consistent with institutional policies and professional norms; otherwise, providers risk making flawed assessments about the effective and appropriate use of interpreters in bilingual health care.
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Affiliation(s)
- Elaine Hsieh
- Department of Communication, University of Oklahoma, 610 Elm Ave #101, Norman, OK, 73019, USA,
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Suurmond J, Seeleman C, Essink-Bot ML. Analyzing Fallacies in Argumentation to Enhance Effectiveness of Educational Interventions: The Case of Care Providers' Arguments Against Using Professional Interpretation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2015; 35:249-254. [PMID: 26953855 DOI: 10.1097/ceh.0000000000000003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Although research has shown that professional interpreters improve health care to patients who do not speak the same language as their care provider, care providers underuse professional interpretation services. To get more insight into the reasons of care providers to underuse professional interpreters, we studied fallacies in their arguments. Fallacies in reasoning may explain why care providers avoid changing their behavior even if they are aware of evidence in favor of such behavior. METHODS We did a secondary analysis of interviews about immigrant patients with care providers collected in two studies on in-hospital pediatric care. Interviews (N = 37) were held in 2009, in the Netherlands. Interviews were analyzed using a contextual approach to fallacious argumentation: a method that can identify fallacies as "wrong" arguments compared with the context in they are made. RESULTS We identified six main fallacies that care providers used to argue that they prefer not to use a professional interpreter while having free access to professional interpreters: 1) There are also some negative side effects to using professional interpreters, 2) there is no language problem, 3) it is such an enormous hassle to organize it, 4) I am a good doctor, 5) my medical information is not complex, and 6) patients do not want it. DISCUSSION Familiarizing care providers with these fallacies can raise their awareness of the wrong arguments to defend their underuse of professional interpreters and can be made part of their training.
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Affiliation(s)
- Jeanine Suurmond
- Drs. Suurmond, Seeleman, and Essink-Bot: Department of Public Health, Academic Medical Centre/University of Amsterdam, Amsterdam, the Netherlands
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