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Gemae MR, Kim P, Sturrock S, Law C. Diversity gaps amongst practicing ophthalmologists in Canada: a landscape study. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00247-3. [PMID: 39178910 DOI: 10.1016/j.jcjo.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/09/2024] [Accepted: 08/02/2024] [Indexed: 08/26/2024]
Abstract
OBJECTIVE Outline geographic disparities in access to language-and gender-concordant ophthalmologic care in Canada. DESIGN Cross-sectional. PARTICIPANTS Practicing ophthalmologists in Canada (September 2023). METHODS Data on ophthalmologists, including demographics, languages spoken, and practice locations, were collected from provincial regulatory body websites. Population data were extracted from the 2021 Statistics Canada Census. Ratio of ophthalmologists-to-potential patients and mean distances (absolute, population-weighted) to gender- and language-concordant care were calculated. The five most common languages spoken in the included provinces were analyzed. RESULTS There were 986 and 1338 ophthalmologists in the language and gender analysis, respectively. Few ophthalmologists spoke non-official languages in Saskatchewan, Manitoba, and Nova Scotia. In a population-weighted analysis, the distance to a language-concordant ophthalmologist were 4.55 times greater for Spanish speakers compared to their English counterparts. Cantonese speakers had the shortest distances to language-concordant care but were still had 40% greater distance than English speakers in the same regions. Despite French-speaking ophthalmologists being the most prevalent per 100 000 speakers, francophones outside Quebec endured distances over double that of anglophones to access language-concordant care. Females in Newfoundland and Saskatchewan faced the longest distances to access gender-concordant care. In Ontario, females may face 3 times the distance to gender-concordant ophthalmologists compared to males. Quebec approaches gender parity with a male-to-female ratio of 55:45. CONCLUSIONS The results highlight the disparities in accessibility to non-English ophthalmologic care and the underrepresentation of female ophthalmologists across Canada. These disparities underscore the need for targeted strategies to ensure that the ophthalmologic workforce mirrors the demographic of the population it serves.
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Affiliation(s)
- Mohamed R Gemae
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Patrick Kim
- School of Medicine, Queen's University, Kingston, ON, Canada
| | - Shelby Sturrock
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Christine Law
- Department of Ophthalmology, Queen's University, Kingston, ON, Canada; Department of Pediatrics, Queen's University, Kingston, ON, Canada.
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Ch'en P, Patel PB, Ramirez M. Caregivers' and Health Care Providers' Cultural Perceptions of and Experiences With Latino Patients With Dementia. Neurol Clin Pract 2024; 14:e200307. [PMID: 38855714 PMCID: PMC11157425 DOI: 10.1212/cpj.0000000000200307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/09/2024] [Indexed: 06/11/2024]
Abstract
Background and Objectives The prevalence of Alzheimer dementia in the US Latino population in 2060 is projected to increase 7-fold, the highest among any other major ethnic/racial group. One vital question is how clinicians can tailor their care for Latinos. Given this rapidly growing prevalence, we sought to characterize the experiences and perspectives of Latino caregivers by analyzing interview data from both caregivers and experienced providers that specifically work with Latino populations. In this study, we present 6 themes that emerged along with tailored solutions and recommendations to implement in clinical practice to improve patient care and outcomes. Methods This qualitative analysis uses coded interview transcripts from 2 studies, one in Southern California and another in Washington State. The combined dataset included interview transcripts with 51 caregivers and 20 providers. A thematic analysis was performed on the coded interview transcripts to identify themes related to tailoring care for Latino populations. Results Six themes emerged from the analysis: (1) multiple caregivers involved within a family-oriented Latino household; (2) need for encouragement in advocating for loved ones in the clinician's office; (3) challenges in reaching and communicating with the Latino population; (4) increasing use of technology by patients and caregivers despite some challenges; (5) stigma associated with mental health issues within the Latino culture; and (6) limited understating of dementia leading to a delay in care in the Latino population. Discussion Many Latino households have a strong sense of familism, thus care coordination with multiple caregivers is essential to high-quality care. Improved shared decision-making strategies tailored to a population that may be culturally deferential to authoritative figures can aid caregiver understanding and engagement with the provider. These interactions can often be more authentic when communicating with a member of the care team in Spanish. A cultural stigma of mental illness was also identified; clinicians can work toward normalizing discussion of mental illness and its treatment by openly discussing mental health during annual visits. Through these themes, we demonstrate some of the strengths and weaknesses of the current care delivery model within a sociocultural context to improve patient care and outcomes for Latino families caring for individuals living with dementia.
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Affiliation(s)
- Peter Ch'en
- Albert Einstein College of Medicine (PC), Bronx, NY; Department of Neurology (PBP); and Department of Health Systems and Population Health (MR), University of Washington, Seattle
| | - Payal B Patel
- Albert Einstein College of Medicine (PC), Bronx, NY; Department of Neurology (PBP); and Department of Health Systems and Population Health (MR), University of Washington, Seattle
| | - Magaly Ramirez
- Albert Einstein College of Medicine (PC), Bronx, NY; Department of Neurology (PBP); and Department of Health Systems and Population Health (MR), University of Washington, Seattle
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Martinez M, Kimiecik C, Nunez JCA, Suárez JDV, Garcia G, Struewing M, Schellhase EM, Gonzalvo JD. Evaluation of a Pilot Spanish Language Program for Student Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100751. [PMID: 38960069 DOI: 10.1016/j.ajpe.2024.100751] [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: 02/05/2024] [Revised: 06/20/2024] [Accepted: 06/28/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE This study aimed to present findings from an evaluation of the Spanish Language Track (SLT) for student pharmacists, which assessed student outcomes and feedback. METHODS A mixed-methods program evaluation was conducted with the first cohort of the SLT members (N = 10). Participants completed pre/post-surveys and focus groups. Quantitative data analysis used descriptive and frequency analysis, while qualitative data were thematically analyzed. RESULTS With a focus on qualitative themes, quantitative results support themes 1, 2, and 3 on the basis of findings from the self-assessment of participants' ability to speak and use the Spanish language. The following 5 themes were identified: (1) initial involvement and motivation to engage; (2) language skill development; (3) health-focused language immersion; (4) strong relationships within the SLT cohort; and (5) opportunities for improvement. CONCLUSION Findings demonstrate students' active engagement with SLT while enhancing language skills through immersive experiences. Their connections with other cohort members, SLT team members, and Colombian pharmacists, and biweekly patient appointment simulations were key contributors to learning outcomes while offering suggestions for programming. The SLT provides a foundational model for health professional programs to offer students opportunities to understand and practice language-concordant health care delivery and promote improved health outcomes in Spanish-speaking populations.
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Affiliation(s)
- Moises Martinez
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Carlyn Kimiecik
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA; Purdue University, Department of Public Health, West Lafayette, IN, USA.
| | - Juan Camilo Alvarez Nunez
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Juan Diego Viracachá Suárez
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Gicelle Garcia
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Mitchell Struewing
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Ellen M Schellhase
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
| | - Jasmine D Gonzalvo
- Purdue University, College of Pharmacy, Department of Pharmacy Practice, Center for Health Equity and Innovation, West Lafayette, IN, USA
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Yang G, Bekele A, Krishnaswami S, Ameh E, Sifri Z, Aisuodionoe-Shadrach O, Swaroop M, Orloff S, Abdullah F, Nwomeh B, Chen M, Charles A, Ezeme C, Juillard C, Menezes C, Chitalu M, Nwariaku F, Jawa RS. Cultural competency and ethical behavior for collaboration in limited-resource settings: Guidelines from the Society of University Surgeons Academic Global Surgery Committee and the Association for Academic Global Surgery. Surgery 2024; 176:108-114. [PMID: 38609784 DOI: 10.1016/j.surg.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/02/2024] [Accepted: 02/26/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND There are an increasing number of global surgery activities worldwide. With such tremendous growth, there is a potential risk for untoward interactions between high-income country members and low-middle income country members, leading to programmatic failure, poor results, and/or low impact. METHODS Key concepts for cultural competency and ethical behavior were generated by the Academic Global Surgery Committee of the Society for University Surgeons in collaboration with the Association for Academic Global Surgery. Both societies ensured active participation from high-income countries and low-middle income countries. RESULTS The guidelines provide a framework for cultural competency and ethical behavior for high-income country members when collaborating with low-middle income country partners by offering recommendations for: (1) preparation for work with low-middle income countries; (2) process standardization; (3) working with the local community; (4) limits of practice; (5) patient autonomy and consent; (6) trainees; (7) potential pitfalls; and (8) gray areas. CONCLUSION The article provides an actionable framework to address potential cultural competency and ethical behavior issues in high-income country - low-middle income country global surgery collaborations.
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Affiliation(s)
- George Yang
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Abebe Bekele
- University of Global Health Equity, Kigali, Rwanda
| | | | - Emmanuel Ameh
- Department of Surgery, National Hospital, Abuja, Nigeria
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | | | - Mamta Swaroop
- Department of Surgery, Kern Medical Center, Bakersfield, CA
| | - Susan Orloff
- Department of Surgery, Oregon Health & Sciences University, Portland, OR
| | - Fizan Abdullah
- Department of Surgery, Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL
| | - Benedict Nwomeh
- Department of Surgery, Ohio State University and Nationwide Childrens Hospital, Columbus, OH
| | - Mike Chen
- Department of Surgery, University of Alabama, Birmingham, AL
| | - Anthony Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Catherine Juillard
- Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | | | | | - Fiemu Nwariaku
- Department of Surgery, University of Utah, Salt Lake City, UT
| | - Randeep S Jawa
- Department of Surgery, Stony Brook Medicine, Stony Brook, NY.
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Fei W, Jinesh S, Nicolas G, Joseph Y, Jason N, Ricci JA. Limited English Proficiency Is Not Associated With Poor Postoperative Outcomes or Follow-Up Rates in Patients Undergoing Breast Reduction Mammoplasty - A Single Institution Retrospective Cohort Study. J Surg Res 2024; 296:689-695. [PMID: 38364696 DOI: 10.1016/j.jss.2024.01.041] [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: 04/17/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Limited English Proficiency (LEP) status has been associated with worse patient outcomes on a variety of metrics. METHODS A retrospective review of all bilateral breast reduction mammoplasty patients at our institution between 2015 and 2019 was performed. Data collected include patient demographics, language status, interpreter usage, complications, and follow-up clinic/emergency department visits. Patients were grouped into high and low follow-up cohorts by median follow-up. Bivariate testing and regression modeling were used for analysis. RESULTS A total of 1023 patients were included. Average age and body mass index (BMI) were 37.7 years and 31.7 kg/m2. All LEP (21%) patients used interpreters. There were 590 individuals in the low follow-up and 433 in the high follow-up group. Those in low follow-up were younger, with lower BMI, and were more likely to use Medicaid. Prevalence of diabetes and postoperative emergency department visits were higher in the high follow-up cohort. There were no significant differences in race/ethnicity, smoking status, and interpreter use between groups. Poisson modeling demonstrated that presence of complications is associated with a 0.435 increase in the number of clinic visits and a 1-y increase in age is associated with a 0.006 increase (P < 0.001). Interpreter use was not significantly associated with postoperative clinic visits. Multivariable regression modeling demonstrated BMI and diabetes to be significantly associated with incidence of any complication (odds ratio: 1.08 & 2.234; P < 0.001 &P = 0.01, respectively). CONCLUSIONS LEP status was not associated with worse postoperative outcomes or follow-up length in patients undergoing breast reduction mammoplasty. This may be due to interpreter use and effective patient education.
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Affiliation(s)
- Wang Fei
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Shah Jinesh
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Greige Nicolas
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Yi Joseph
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Ni Jason
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Joseph A Ricci
- Division of Plastic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
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Waselewski M, Amaro X, Huerto R, Berger J, Spinelli da Silva M, Siroky K, Torres A, Chang T. Youth preferences for healthcare providers and healthcare interactions: a qualitative study. BMC PRIMARY CARE 2024; 25:63. [PMID: 38383303 PMCID: PMC10882742 DOI: 10.1186/s12875-024-02300-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Patient-physician relationships in healthcare can influence healthcare provision, patient engagement, and health outcomes. Little is known about youth preferences on types and characteristics of their healthcare providers. The aim of this study was to assess youth perspectives on preferences for and interactions with their healthcare providers. METHODS We posed 5 open-ended questions to 1,163 MyVoice participants, a nationwide text message cohort of United States youth aged 14-24, on April 10, 2020 related to youth preferences for healthcare providers. Content analysis was used to develop a codebook. Responses were independently coded by two reviewers with discrepancies discussed to reach consensus. Descriptive statistics were calculated for demographics and frequency of codes. RESULTS 944 (81%) participants responded to at least one question. Respondents had a mean age of 18.9 years (SD: 2.8) and were a majority female (53.6%) and White (56.3%). Youth reported "kindness" or other personality traits (31%) and education (30%) as important in choosing their doctor. Patient-physician concordance was not important to many youths (44%) and among those who reported concordance as important (55%), having the same gender was the most noted (68%). Youth suggested respect, open conversation, and addressing issues directly to help alleviate uncomfortable situations, though some would simply switch providers. CONCLUSION Personality and empathy are important provider characteristics valued by youth. Female respondents preferred gender concordant providers, particularly for sexual health-related issues, and non-white respondents were more likely to prefer racial concordance. Strengthening professional and interpersonal skills among youth-serving providers may improve healthcare engagement and satisfaction among youth.
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Affiliation(s)
- Marika Waselewski
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA
| | | | - Ryan Huerto
- Department of Adult and Family Medicine, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jessica Berger
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA
- University of Michigan, Ann Arbor, MI, USA
| | | | - Kate Siroky
- School of Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Tammy Chang
- Department of Family Medicine, University of Michigan, 2800 Plymouth Road, Building 14 G128, Ann Arbor, MI, 48109, USA.
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
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Rizkallah J, Staios M, Analytis P, Kosmidis MH, March E, Stolwyk RJ. Exploring How Sociocultural Factors Affect the Experience of Completing Neuropsychological Assessments Within Older Greek-Australians. Arch Clin Neuropsychol 2024; 39:65-77. [PMID: 37332261 PMCID: PMC10802220 DOI: 10.1093/arclin/acad044] [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: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE The field of cultural neuropsychology has grown exponentially over the last three decades. With a limited culturally informed evidence base to guide neuropsychological practice, the acceptability of existing paradigms has been called into question when applied to culturally diverse and educationally disadvantaged groups. This qualitative study aimed to explore the experiences of Greek Australian older adults who underwent a cognitive assessment to better understand potential barriers and facilitators to engagement and to improve neuropsychological assessment outcomes. METHOD Semi-structured interviews were developed to explore cultural attitudes and contextual factors relating to neuropsychological assessment. Interviews were conducted by Greek-speaking neuropsychologists using a sample of 10 healthy elderly Greek Australians following the completion of a comprehensive neuropsychological assessment. Data were analyzed using a phenomenological design within a critical realist framework. RESULTS Analysis revealed the emergence of three broad themes: sociocultural factors, experiences within the broader medical system, and the assessment experience. Engagement with cognitive assessment was influenced by several factors, including rapport building, understanding of the assessment, and use of inappropriate tests. Furthermore, level and quality of education, sex differences, language barriers, acculturation, previous experiences of prejudice, anxiety, and a preference for Greek-speaking clinicians were additional factors reported to affect the client experience and validity of assessment outcomes. CONCLUSION Neuropsychological assessment is, in part, affected by culturally reinforced attitudes. Failing to adjust the relationship between the clinician and client, test environment, style of communication, and the use of culturally inappropriate tests is likely to affect the validity of assessment outcomes.
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Affiliation(s)
- Joyce Rizkallah
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Mathew Staios
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Penelope Analytis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Evrim March
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Australia
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Guitard P, Toal-Sullivan D. The influence of occupational therapy students' preferred language on academic and clinical performance in a Canadian university program. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2023; 28:1615-1632. [PMID: 37222885 DOI: 10.1007/s10459-023-10226-x] [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: 06/12/2022] [Accepted: 03/19/2023] [Indexed: 05/25/2023]
Abstract
The Occupational Therapy Program at this Canadian university is a French program however, students must be bilingual to function in English or French clinical fieldwork settings. An understanding of the role of language in successful completion of program requirements was needed to effectively support students' education. The study objectives were to identify the role of linguistic factors in students' academic and clinical performance and to provide recommendations for strategies to address areas of learning difficulty. A multimethod approach used 4 data sources: (1) Multiple Mini Interview (MMI) informal language assessment scores, (2) grade point average (GPA), (3) fieldwork evaluation reports, and (4) an online survey of program graduates. The GPA on admission and MMI scores of 140 students predicted respectively only 20% and 2% of the variation in GPA on program completion. The areas of poorest performance in failed clinical fieldwork reports were in clinical reasoning and communication competencies. Among survey respondents (n = 47), 44.5% reported that a clinical placement in their second language with related charting (51.6%) and client communication (40.9%) were the most significant difficulties encountered in the program. Clients with mental health issues (45.4%) were the most challenging population to work with, attributed to communication barriers in the students' second language. Strategies are proposed to support occupational therapy students' academic and clinical language proficiency, including conversational training courses, problem-based learning activities in students' second language, focussed teaching on the clinical reasoning process and reflective skills, and language coaching to address early signs of difficulty in clinical fieldwork.
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Affiliation(s)
- Paulette Guitard
- Faculty of Health Sciences, University of Ottawa, Guindon Hall, Room 3059, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Darene Toal-Sullivan
- School of Rehabilitation Sciences, Occupational Therapy Program, University of Ottawa, Guindon Hall, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
- , Almonte, Canada.
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Schrewe B, Yeuchyk T, Hafid ME, Nyhof-Young J. Educating future physicians for francophone official language minority communities in Canada: a case study. CANADIAN MEDICAL EDUCATION JOURNAL 2023; 14:20-30. [PMID: 38226309 PMCID: PMC10787852 DOI: 10.36834/cmej.75300] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Background Over one million Francophone Canadians live in official language minority communities (OLMC) outside of Québec. Availability and accessibility of linguistically appropriate care to these OLMCs is lacking, resulting in poorer quality of care. To help address this health equity gap, the FrancoDoc program was created in 2015 to identify Francophone/Francophile medical students enrolled at medical faculties that use English as their primary language of instruction and equip them with skills to increase their medical French abilities. Little is known, however, about the affordances and limitations of this educational endeavour. Methods Our qualitative instrumental single case study explored participants' experiences with FrancoDoc, while also examining factors shaping the delivery of linguistically appropriate healthcare services to OLMCs. We conducted semi-structured interviews with medical students from across Canada and thematically analyzed these using a reflexive, inductive approach. Results Four main themes were derived from 12 interviews: factors facilitating French language learning; barriers to French language learning; contextual factors shaping linguistically appropriate healthcare provision; and recommendations to improve healthcare education to better prepare learners to provide care to OLMCs. Conclusions Medical student participants are highly motivated to engage in educational activities linked to FrancoDoc. Their efforts are nonetheless frequently impeded by barriers such as time constraints, irregular event programming, lack of regular clinical learning opportunities, and lukewarm support from faculties of medicine. If medical faculties are to realize their obligations to the OLMCs that they serve, recognition of language as a specific social determinant of health and more robust institutional supports for initiatives like FrancoDoc are paramount.
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Affiliation(s)
- Brett Schrewe
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Tatiana Yeuchyk
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Melanie El Hafid
- Department of General Surgery, University of Saskatchewan, Saskatchewan, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
- Women’s College Hospital, Ontario, Canada
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10
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Wang F, Rothchild E, Lu YH, Ricci JA. Language Disparity Predicts Poor Patient-Reported Outcome and Follow-Up in Microsurgical Breast Reconstruction. J Reconstr Microsurg 2023; 39:681-694. [PMID: 36809784 DOI: 10.1055/a-2040-1750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Patients with limited English proficiency (LEP) have starkly different health care experiences compared with their English-proficient counterparts. The authors aim to examine the link between LEP and postoperative outcomes in patients undergoing microsurgical breast reconstruction. METHODS A retrospective review of all patients who underwent abdominal-based microsurgical breast reconstruction at our institution between 2009 and 2019 was performed. Variables collected included patient demographics, language status, interpreter usage, perioperative complications, follow-up visits, and self-reported outcomes (Breast-Q). Pearson's χ 2 test, Student's t-test, odds ratio analysis, and regression modeling were used for analysis. RESULTS A total of 405 patients were included. LEP patients comprised 22.22% of the overall cohort with 80% of LEP patients utilizing interpreter services. LEP patients reported significantly lower satisfaction with an abdominal appearance at the 6-month follow-up and lower physical and sexual well-being scores at the 1-year follow-up (p = 0.05, 0.02, 0.01, respectively). Non-LEP patients had significantly longer operative times (539.6 vs. 499.3 minutes, p = 0.024), were more likely to have postoperative donor site revisions (p = 0.05), and more likely to receive preoperative neuraxial anesthesia (p = 0.01). After adjusting for confounders, LEP stats was associated with 0.93 fewer follow-up visits (p = 0.02). Interestingly, compared with LEP patients who did not receive interpreter services, LEP patients who did had 1.98 more follow-up visits (p = 0.02). There were no significant differences in emergency room visits or complications between the cohorts. CONCLUSION Our findings suggest that language disparities exist within microsurgical breast reconstruction and underscore the importance of effective, language-conscious communication between surgeon and patient.
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Affiliation(s)
- Fei Wang
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Evan Rothchild
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Yi-Hsueh Lu
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Joseph A Ricci
- The Division of Plastic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Garcia ME, Williams M, Mutha S, Diamond LC, Jih J, Handley MA, Pathak S, Karliner LS. Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment. J Gen Intern Med 2023; 38:3099-3106. [PMID: 37620723 PMCID: PMC10651569 DOI: 10.1007/s11606-023-08354-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Language concordance can increase access to care for patients with language barriers and improve patient health outcomes. However, systematically assessing and tracking physician non-English language skills remains uncommon in most health systems. This is a missed opportunity for health systems to maximize language-concordant care. OBJECTIVE To determine barriers and facilitators to participation in non-English language proficiency assessment among primary care physicians. DESIGN Qualitative, semi-structured interviews. PARTICIPANTS Eleven fully and partially bilingual primary care physicians from a large academic health system with a language certification program (using a clinician oral proficiency interview). APPROACH Interviews aimed to identify barriers and facilitators to participation in non-English language assessment. Two researchers independently and iteratively coded transcripts using a thematic analysis approach with constant comparison to identify themes. KEY RESULTS Most participants were women (N= 9; 82%). Participants reported proficiency in Cantonese, Mandarin, Russian, and Spanish. All fully bilingual participants (n=5) had passed the language assessment; of the partially bilingual participants (n=6), four did not test, one passed with marginal proficiency, and one did not pass. Three themes emerged as barriers to assessment participation: (1) beliefs about the negative consequences (emotional and material) of not passing the test, (2) time constraints and competing demands, and (3) challenging test format and structure. Four themes emerged as facilitators to increase assessment adoption: (1) messaging consistent with professional ethos, (2) organizational culture that incentivizes certification, (3) personal empowerment about language proficiency, and (4) individuals championing certification. CONCLUSIONS To increase language assessment participation and thus ensure quality language-concordant care, health systems must address the identified barriers physicians experience and leverage potential facilitators. Findings can inform health system interventions to standardize the requirements and process, increase transparency, provide resources for preparation and remediation, utilize messaging focused on patient care quality and safety, and incentivize participation.
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Affiliation(s)
- Maria Esteli Garcia
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA.
- Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA.
- PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA.
| | - Mia Williams
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
| | - Sunita Mutha
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
- Healthforce Center, University of California, San Francisco, CA, USA
| | - Lisa C Diamond
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Hospital Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jane Jih
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
- Asian American Research Center on Health, San Francisco, CA, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, Implementation Science Training Program, UCSF, San Francisco, CA, USA
- PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA
- Department of Medicine, University of California, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, San Francisco, CA, USA
| | - Sarita Pathak
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Department of Medicine, Multiethnic Health Equity Research Center, University of California, 1701 Divisadero St. Room 536, San Francisco, CA, 94143-1731, USA
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Truong S, Foley OW, Fallah P, Lalla AT, Osterbur Badhey M, Boatin AA, Mitchell CM, Bryant AS, Molina RL. Transcending Language Barriers in Obstetrics and Gynecology: A Critical Dimension for Health Equity. Obstet Gynecol 2023; 142:809-817. [PMID: 37678884 PMCID: PMC10510840 DOI: 10.1097/aog.0000000000005334] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 09/09/2023]
Abstract
There is growing evidence that language discordance between patients and their health care teams negatively affects quality of care, experience of care, and health outcomes, yet there is limited guidance on best practices for advancing equitable care for patients who have language barriers within obstetrics and gynecology. In this commentary, we present two cases of language-discordant care and a framework for addressing language as a critical lens for health inequities in obstetrics and gynecology, which includes a variety of clinical settings such as labor and delivery, perioperative care, outpatient clinics, and inpatient services, as well as sensitivity around reproductive health topics. The proposed framework explores drivers of language-related inequities at the clinician, health system, and societal level. We end with actionable recommendations for enhancing equitable care for patients experiencing language barriers. Because language and communication barriers undergird other structural drivers of inequities in reproductive health outcomes, we urge obstetrician-gynecologists to prioritize improving care for patients experiencing language barriers.
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Affiliation(s)
- Samantha Truong
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and the Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Chicago, Illinois
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Brumbaugh JE, Tschida‐Reuter DJ, Barwise AK. Meeting the needs of the patient with non-English language preference in the hospital setting. Health Serv Res 2023; 58:965-969. [PMID: 37580055 PMCID: PMC10480083 DOI: 10.1111/1475-6773.14217] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023] Open
Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent MedicineMayo ClinicRochesterMinnesotaUSA
| | | | - Amelia K. Barwise
- Program in Biomedical Ethics Research and Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterMinnesotaUSA
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14
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Gresh A, Ahmed N, Boynton-Jarrett R, Sharifi M, Rosenthal MS, Fenick AM. Clinicians' Perspectives on Equitable Health Care Delivery in Group Well-Child Care. Acad Pediatr 2023; 23:1385-1393. [PMID: 37302699 DOI: 10.1016/j.acap.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/14/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore clinicians' perspectives about the impact of group well-child care (GWCC) on equitable health care delivery. METHODS In this qualitative study, we conducted semistructured interviews with clinicians engaged in GWCC recruited via purposive and snowball sampling. We first conducted a deductive content analysis using constructs from Donabedian's framework for health care quality (structure, process, and outcomes) followed by inductive thematic analysis within these constructs. RESULTS We completed 20 interviews with clinicians who deliver or research GWCC in 11 institutions across the United States. Four major themes around equitable health care delivery in GWCC emerged from clinicians' perspectives: 1) shifts in power dynamics (process); 2) enabling relational care, social support, and a sense of community (process, outcome); 3) centering multidisciplinary care delivery around patient and family needs (structure, process, and outcomes); and 4) unaddressed social and structural barriers limit patient and family participation. CONCLUSIONS Clinicians perceived that GWCC enhances equity in health care delivery by shifting hierarchies in clinical visits and promoting relational, patient, and family-centered care. However, potential opportunities exist to further address provider implicit bias in group care delivery and structural inequities at the level of the health care institution. Clinicians underscored the need to address barriers to participation so that GWCC can more fully enhance equitable health care delivery.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing (A Gresh), Baltimore, Md
| | - Noureen Ahmed
- Department of Social and Behavioral Science, Yale School of Public Health (N Ahmed and M Sharifi), New Haven, Conn
| | - Renée Boynton-Jarrett
- Department of Pediatrics, Boston University School of Medicine (R Boynton-Jarrett), Mass
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn; Department of Biostatistics, Yale School of Public Health (M Sharifi), New Haven, Conn
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn
| | - Ada M Fenick
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn.
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Mueller R, Sias JJ, Griffiths C. Medical Spanish in Pharmacy Education: A Call to Action. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100004. [PMID: 37380258 DOI: 10.1016/j.ajpe.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The Spanish-speaking population in the United States is large, growing, and diverse. There is an increasing need for pharmacists to be linguistically and culturally equipped to provide safe and effective care to this population. Therefore, pharmacy educators should help prepare and train students for this responsibility. Although there are a variety of noteworthy initiatives within pharmacy education relating to medical Spanish, a need exists for a more consistent, robust, and evidence-based approach. Collaboration and innovation are needed to overcome this challenge and meet this need. A call to action is issued for pharmacy education programs to evaluate the demographics, need, and feasibility of offering experiences in Spanish and other relevant foreign languages, expand opportunities in medical Spanish, emphasize key content areas within medical Spanish education, and encourage the use of evidence-based practices in language acquisition and professional use.
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Affiliation(s)
- Robert Mueller
- Concordia University Wisconsin School of Pharmacy, Mequon, WI, USA.
| | - Jeri J Sias
- The University of Texas at El Paso School of Pharmacy, El Paso, TX, USA
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16
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Kaplan TB, Doughty C, Budhu J. Incorporating health equity in the neurology curriculum: Our experience. J Neurol Sci 2023; 449:120665. [PMID: 37146543 DOI: 10.1016/j.jns.2023.120665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Social determinants of health (SDoH) are responsible for 80-90% of modifiable contributors to health, yet this material may not be covered in preclinical medical school neuroscience courses. OBJECTIVE To describe how topics related to SDoH and inclusion, diversity, equity, anti-racism, and social justice (IDEAS) were incorporated into a preclinical neuroscience course. METHODS IDEAS concepts and guided discussions were added to our existing case-based curriculum, and guest speakers were invited to discuss how these concepts are relevant in the field of neurology. RESULTS Most students felt that content and discussions were integrated thoughtfully. Students also found it helpful to learn and observe how faculty address these topics in real-world cases. CONCLUSION The additional content related to SDoH and IDEAS is feasible. Faculty with or without expertise in IDEAS concepts were able to utilize these cases and generate discussion without detracting from the neuroscience course material.
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Affiliation(s)
- T B Kaplan
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - C Doughty
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - J Budhu
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Quraishi Z. Addressing mental health, misinformation, & religious tensions among South Asian students across California higher education during the COVID-19 pandemic: A qualitative research study. Heliyon 2023; 9:e16396. [PMID: 37274702 PMCID: PMC10238891 DOI: 10.1016/j.heliyon.2023.e16396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 06/06/2023] Open
Abstract
Background South Asian Americans comprise one of the fastest-growing ethnic groups in the US. Nevertheless, the scientific literature on the experiences of South Asian students is lacking, where often studies focused on Asian Americans exclude South Asians altogether. South Asian students have unique experiences in California higher education, often having to cope with high pressure to perform academically and various social responsibilities associated with being first-, second-, or third-generation American.Many South Asian countries have been more severely affected by COVID-19 due to the density of people living in close proximity to one another. Students of South Asian origin worry for their families overseas, especially as the COVID-19 pandemic has impacted populations there to a more considerable extent. Methodology This was a qualitative research study conducted using in-depth interviews with 25 students who identified as South Asian and were currently enrolled in higher education in California at the time they were interviewed. Ads were placed on social media networks, such as Facebook and Twitter, and participation in the study was voluntary. Students were chosen randomly to avoid bias. Study participants described their experiences navigating higher education throughout the ongoing COVID-19 pandemic in relation to their social, economic, cultural, and political spheres. Interviews were mainly conducted through Zoom, some through emails or phone calls. All participants will remain anonymous to protect the identities of students.This project sought to understand the experiences of South Asian students as they navigate the new normal amidst a global crisis. Qualitative responses were indexed by themes, with South Asian students reporting a relationship between the pandemic and worsened academic experiences, issues of exacerbated mental health, the spread of misinformation, and increased religious tensions.This research reflects pragmatism, and the findings of this paper are coupled with suggested recommendations to ameliorate pandemic related issues for future South Asian students. The project was conducted through both inductive and qualitative approaches. The research strategy is action research, and the research was meant to shine a light on issues South Asian students face and help university administrations understand how to better support students during a pandemic. The time horizon is cross-sectional. The research focuses on COVID-19 in relation to South Asian students' performance and health.At 25 participants, data saturation was reached. Further participants were not needed as the qualitative research data was sufficient to draw conclusions from. The research was deemed to pose no risk to students; therefore, approval from an ethical committee was not sought. All participants signed consent forms in order to participate.Follow-up interviews were conducted to address students' experiences with family in India experiencing the B.167.2 variant and the transition back to in-person learning following virtual schooling. Conclusions/significance South Asian students in higher education bear a unique set of responsibilities in addition to the already rigorous coursework associated with college. However, the stresses and health of South Asian students often go understudied or overlooked. This research serves to begin to fill in the gaps in literature of South Asian experiences in higher education.The pandemic posed additional challenges for students, who lost access to their campus communities with university education going virtual, and many South Asian students had to move back home. Through this qualitative research study analyzing the experiences of South Asians enrolled in California higher education, it can be concluded that there is a relationship between the COVID-19 pandemic and students' academic performance, mental health, as well as an increase in the amount of misinformation spread regarding COVID-19 public safety guidelines.
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Eden A, Cominos N, Fleet JA. Agency in change: Learning experiences of international midwifery students in South Australia. Women Birth 2023; 36:143-150. [PMID: 36494305 DOI: 10.1016/j.wombi.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
PROBLEM While literature reports broadly on the experiences of international students of health professions in higher education, the experience of students undertaking an undergraduate midwifery program outside their country of origin has not previously been reported. BACKGROUND Midwifery studies incorporate distinct clinical practice and discipline-specific therapeutic relationships which can challenge students familiar with the health system, so it is necessary to understand their impact on the learning needs of international students, who contribute to the diversity of our workforce. AIM To explore learning experiences of international students of an undergraduate midwifery program to identify their perceptions and personal strategies which impacted their participation in the program. METHODS A qualitative descriptive study, with a purposive sample of nine current international students and recent graduates of a midwifery program at a South Australian university. Participants attended a focus group or individual phone interview to explore their learning experiences, and data were thematically analysed. FINDINGS Five themes and sub-themes were identified, built around a core concept of the international midwifery student experience as agency in change: language and culture, teaching and learning, isolation and integration, services and support, and motivation and resilience. Studying abroad was associated with personal and professional growth. Continuity of care for women presented challenges and produced learnings unique to this cohort. CONCLUSION Tailored support, such as specialized clinical facilitation and organized peer networking, is required for international midwifery students in Australia. Additionally, effective approaches to facilitate bilingualism to support language concordant care are needed.
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Affiliation(s)
- Amye Eden
- Clinical and Health Sciences, University of South Australia, City East Campus, Corner North Terrace and Frome Road, Adelaide, SA 5000, Australia.
| | - Nayia Cominos
- College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia.
| | - Julie-Anne Fleet
- Rosemary Bryant AO Research Centre, University of South Australia, City East Campus, Corner North Terrace and Frome Road, Adelaide, SA 5000, Australia.
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Diversity among research coordinators in a pediatric emergency medicine research collaborative network. J Clin Transl Sci 2023; 7:e46. [PMID: 36845308 PMCID: PMC9947600 DOI: 10.1017/cts.2022.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
We conducted a survey study of clinical research coordinators (CRCs) at the member institutions of the Pediatric Emergency Care Applied Research Network, to determine the demographic and linguistic characteristics of CRCs around the network, and any perceived impact of those characteristics on their duties. A total of 53/74 CRCs completed the survey. Most respondents identified as "female," "white," and "not Hispanic/Latino." Most respondents felt that their race/ethnicity and their ability to speak a language other than English would positively impact recruitment. Four female respondents felt that their gender hindered their recruitment efforts and their sense of belonging within the research team.
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Mustafa R, Mahboob U, Khan RA, Anjum A. Impact of Language Barriers in Doctor - Patient Relationship: A Qualitative Study. Pak J Med Sci 2023; 39:41-45. [PMID: 36694787 PMCID: PMC9842973 DOI: 10.12669/pjms.39.1.5805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To explore the problems faced by recent medical graduates in communication with their patients due to language barriers and the influence of these language barriers on the doctor-patient relationship. Methods A basic qualitative study was conducted at Allama Iqbal Memorial Teaching Hospital Sialkot, Services Hospital Lahore and Mayo Hospital Lahore over eight months after receiving approval from the Ethical Review Board of the University of Lahore. Twelve recent medical graduates from different departments were selected via a purposive sampling technique. Data was collected through semi-structured interviews conducted over the phone with prior appointments. Manual qualitative thematic analysis was done by transcribing the interview and then codes, subthemes, and themes were generated. Results Six themes and thirteen subthemes were identified depicting the influence of language barriers on the doctor-patient relationship, namely: frustration (due to repetition, feeling of inadequacy & disappointment), lack of rapport (difficulty in communication, effective counseling & failure in establishment of comfort level), trust Issues (predilection towards the native speaker & difficulty in getting consent) patient dissatisfaction, compliance issues (difficulty in comprehending medication & nature of disease), and threat to patient safety (misdiagnosis & consequent treatment plan & misinterpretation of treatment). Conclusion This study establishes the detrimental effects of language barriers on the relationship between physician and patient which can help medical educationists and policymakers in devising a curriculum in such a way that it can minimize the impact of language barriers on the doctor-patient relationship.
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Affiliation(s)
- Remsha Mustafa
- Dr. Remsha Mustafa, MBBS, MHPE. Assistant Professor, Department of Medical Education, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
| | - Usman Mahboob
- Dr. Usman Mahboob, MBBS, MPH, FHEA, DHPE, Fellow FAIMER. Associate Professor, Institute of Health Professions Education & Research, Khyber Medical University, Peshawar, Pakistan
| | - Rehan Ahmed Khan
- Dr. Rehan Ahmed Khan, MBBS, FCPS, FRCS, JM-HPE, Ph.D. Assistant Dean of Medical Education, Professor of Surgery, Islamic International Medical College, Riphah International University, Rawalpindi, Pakistan
| | - Abeer Anjum
- Dr. Abeer Anjum, MBBS, MHPE. Assistant Professor, Department of Medical Education, Khawaja Muhammad Safdar Medical College, Sialkot, Pakistan
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Himmelstein J, Cai C, Himmelstein DU, Woolhandler S, Bor DH, Dickman SL, McCormick D. Specialty Care Utilization Among Adults with Limited English Proficiency. J Gen Intern Med 2022; 37:4130-4136. [PMID: 35349026 PMCID: PMC9708984 DOI: 10.1007/s11606-022-07477-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied. OBJECTIVE To compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP. DESIGN Multivariable negative binomial regression analysis of nationally representative data from the Medical Expenditure Panel Survey (pooled 2013-2018) with adjustment for age, sex, and self-reported health status. PARTICIPANTS 149,611 survey respondents aged 18 and older. EXPOSURE LEP, defined as taking the survey in a language other than English. MAIN MEASURES Annual per capita adjusted visit rate ratios (ARRs) comparing visit rates by LEP and EP persons to individual specialties, and to three categories of specialties: (1) primary care (internal or family medicine, geriatrics, general practice, or obstetrics/gynecology), (2) medical-subspecialties, or (3) surgical specialties. KEY RESULTS Patients with LEP were underrepresented in 26 of 28 specialties. Disparities were particularly large for the following: pulmonology (ARR, 0.26; 95% CI, 0.20-0.35), orthopedics (ARR, 0.35; 95% CI, 0.30-0.40), otolaryngology (ARR, 0.40; 95% CI, 0.27-0.59), and psychiatry (ARR, 0.43; 95% CI, 0.32-0.58). Among individuals with several specific common chronic conditions, LEP-EP disparities in visits to specialties in those conditions generally persisted. Disparities were larger for medical subspecialties (ARR, 0.41; 95% CI, 0.36-0.46) and surgical specialties (ARR, 0.46; 95% CI, 0.42-0.50) than for primary care (ARR, 0.76; 95% CI, 0.72 to 0.79). CONCLUSIONS Patients with LEP are underrepresented in most outpatient specialty practices, particularly medical subspecialties and surgical specialties. Our findings highlight the need to remove language barriers to physician services in order to ensure access to the full spectrum of outpatient specialty care for people with LEP.
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Affiliation(s)
- Jessica Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christopher Cai
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- City University of New York at Hunter College, New York, NY, USA
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- City University of New York at Hunter College, New York, NY, USA
| | - David H Bor
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samuel L Dickman
- Planned Parenthood South Texas, San Antonio, TX, USA
- The University of Texas at Austin, Austin, TX, USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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Cultural Considerations in Fahr's Syndrome: A Case Report. Clin Neuropharmacol 2022; 45:148-149. [PMID: 36093905 DOI: 10.1097/wnf.0000000000000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Many psychiatrists, and other providers alike, find difficulty integrating a culture-centered approach to clinical practice and navigating the challenges when they arise. We call attention to the ongoing challenges of addressing the cultural barriers between patient and physician. METHODS We present a case of an African patient with a rare case of Fahr's syndrome whose clinical diagnostic course was complicated by culture and language barriers. RESULTS The patient's hospital course was challenged by cultural and language barriers that were difficult to integrate into her care, likely contributing to a prolonged diagnostic course and hospitalization. CONCLUSIONS Cultural considerations in medicine can enhance patient-physician relationships and ultimately strengthen clinical outcomes.
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Kelson M, Nguyen A, Chaudhry A, Roth P. Improving Patient Satisfaction in the Hispanic American Community. Cureus 2022; 14:e27739. [PMID: 36106297 PMCID: PMC9445777 DOI: 10.7759/cureus.27739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Hispanic Americans are the fastest growing ethnic group in the United States, with an ever-growing gap in the communicative capacity between patients and healthcare providers. This leads to linguistic marginalization and worse healthcare outcomes. There is an increasing need for Spanish literacy in healthcare professionals, including medical students. However, approximately half of medical schools don’t offer a Spanish elective. We performed a scoping review of the literature to assess the relationship between medical Spanish electives, verbal fluency, auditory comprehension, and student comfort. This study was conducted using PubMed and Google Scholar to evaluate articles on Spanish electives in medical schools. Nine articles met inclusion criteria. Almost all studies demonstrated benefit as per outcome measures assessed with statistical significance. The available literature supports the need for Spanish elective courses, with numerous advantages conferred, e.g. increased self-perceived knowledge about specific health issues in the Hispanic American community and reduction in inadvertent communication errors in the patient-provider-interpreter interaction. However, most of the reports analyzed exhibited numerous limitations that warrant future research studies in order to eliminate variables such as bias and issues with generalizability. The authors suggest that more medical schools offer virtual Spanish electives with a focus on empathetic language strategies and patient satisfaction.
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Khan A, Parente V, Baird JD, Patel SJ, Cray S, Graham DA, Halley M, Johnson T, Knoebel E, Lewis KD, Liss I, Romano EM, Trivedi S, Spector ND, Landrigan CP, Bass EJ, Calaman S, Fegley AE, Knighton AJ, O'Toole JK, Sectish TC, Srivastava R, Starmer AJ, West DC. Association of Patient and Family Reports of Hospital Safety Climate With Language Proficiency in the US. JAMA Pediatr 2022; 176:776-786. [PMID: 35696195 PMCID: PMC9194750 DOI: 10.1001/jamapediatrics.2022.1831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Patients with language barriers have a higher risk of experiencing hospital safety events. This study hypothesized that language barriers would be associated with poorer perceptions of hospital safety climate relating to communication openness. OBJECTIVE To examine disparities in reported hospital safety climate by language proficiency in a cohort of hospitalized children and their families. DESIGN, SETTING, AND PARTICIPANTS This cohort study conducted from April 29, 2019, through March 1, 2020, included pediatric patients and parents or caregivers of hospitalized children at general and subspecialty units at 21 US hospitals. Randomly selected Arabic-, Chinese-, English-, and Spanish-speaking hospitalized patients and families were approached before hospital discharge and were included in the analysis if they provided both language proficiency and health literacy data. Participants self-rated language proficiency via surveys. Limited English proficiency was defined as an answer of anything other than "very well" to the question "how well do you speak English?" MAIN OUTCOMES AND MEASURES Primary outcomes were top-box (top most; eg, strongly agree) 5-point Likert scale ratings for 3 Children's Hospital Safety Climate Questionnaire communication openness items: (1) freely speaking up if you see something that may negatively affect care (top-box response: strongly agree), (2) questioning decisions or actions of health care providers (top-box response: strongly agree), and (3) being afraid to ask questions when something does not seem right (top-box response: strongly disagree [reverse-coded item]). Covariates included health literacy and sociodemographic characteristics. Logistic regression was used with generalized estimating equations to control for clustering by site to model associations between openness items and language proficiency, adjusting for health literacy and sociodemographic characteristics. RESULTS Of 813 patients, parents, and caregivers who were approached to participate in the study, 608 completed surveys (74.8% response rate). A total of 87.7% (533 of 608) of participants (434 [82.0%] female individuals) completed language proficiency and health literacy items and were included in the analyses; of these, 14.1% (75) had limited English proficiency. Participants with limited English proficiency had lower odds of freely speaking up if they see something that may negatively affect care (adjusted odds ratio [aOR], 0.26; 95% CI, 0.15-0.43), questioning decisions or actions of health care providers (aOR, 0.19; 95% CI, 0.09-0.41), and being unafraid to ask questions when something does not seem right (aOR, 0.44; 95% CI, 0.27-0.71). Individuals with limited health literacy (aOR, 0.66; 95% CI, 0.48-0.91) and a lower level of educational attainment (aOR, 0.59; 95% CI, 0.36-0.95) were also less likely to question decisions or actions. CONCLUSIONS AND RELEVANCE This cohort study found that limited English proficiency was associated with lower odds of speaking up, questioning decisions or actions of providers, and being unafraid to ask questions when something does not seem right. This disparity may contribute to higher hospital safety risk for patients with limited English proficiency. Dedicated efforts to improve communication with patients and families with limited English proficiency are necessary to improve hospital safety and reduce disparities.
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Affiliation(s)
- Alisa Khan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Victoria Parente
- Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jennifer D. Baird
- Institute for Nursing and Interprofessional Research, Children’s Hospital Los Angeles, Los Angeles, California
| | - Shilpa J. Patel
- Department of Pediatrics, Hawaii Pacific Health, Honolulu,Department of Pediatrics, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Sharon Cray
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania,Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Dionne A. Graham
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Monique Halley
- Patient and Family Centered I-PASS SCORE Family Advisory Council, Boston, Massachusetts
| | - Tyler Johnson
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Erin Knoebel
- Department of Pediatrics and Adolescent Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Kheyandra D. Lewis
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania,Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Isabella Liss
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Eileen M. Romano
- Department of Nursing, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Shrunjal Trivedi
- Program for Patient Safety and Quality, Boston Children’s Hospital, Boston, Massachusetts
| | - Nancy D. Spector
- Department of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania,The Hedwig van Ameringen Executive Leadership in Academic Medicine Program, Philadelphia, Pennsylvania
| | - Christopher P. Landrigan
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts,Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Ellen J Bass
- Department of Information Science, College of Computing and Informatics, Drexel University, Philadelphia, Pennsylvania.,Department of Health Systems and Science Research, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania
| | - Sharon Calaman
- Department of Pediatrics, New York University Grossman School of Medicine, New York.,New York University Langone Health/Hassenfeld Children's Hospital, New York
| | - April E Fegley
- Society of Hospital Medicine, Philadelphia, Pennsylvania
| | - Andrew J Knighton
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah
| | - Jennifer K O'Toole
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.,Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Theodore C Sectish
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Rajendu Srivastava
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah.,Department of Pediatrics, University of Utah School of Medicine, Salt Lake City.,Primary Children's Medical Center, Salt Lake City, Utah
| | - Amy J Starmer
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Daniel C West
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.,Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Menon U, Szalacha LA, Martinez GA, Graham MC, Pares-Avila JA, Rechenberg K, Stauber LS. Efficacy of a language-concordant health coaching intervention for latinx with diabetes. PATIENT EDUCATION AND COUNSELING 2022; 105:2174-2182. [PMID: 34895775 PMCID: PMC9142757 DOI: 10.1016/j.pec.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the effect of a language-concordant health coaching intervention for Spanish-speaking patients with limited English proficiency (LEP) and uncontrolled Type 2 Diabetes (T2D) on glycemic control, anxiety, depression, and diabetes self-efficacy. METHODS 64 patients with T2D were randomly assigned to a control or intervention group. Outcomes were assessed by blood work and surveys pre and post intervention. RESULTS The mean sample age was 47.8 years (SD=11.3) and 81% were female. HbA1c was not significantly different between groups at baseline. The intervention group's HbA1c was significantly lower at times 2 and 3 than in the control arm (p < .01 and p < .001). There were significant reductions in the intervention group's mean HbA1c levels from baseline 10.37 to midpoint 9.20, p < .001; and from baseline 10.42 to study end 8.14, p < .001. Depression and anxiety scores significantly decreased (p < .05 and p < .001), and diabetes self-efficacy significantly increased (p < .001). CONCLUSION Health coaching led to statistically significant and clinically meaningful decreases in HbA1c, depression, and anxiety scores among LEP Latinx adults with uncontrolled T2D. PRACTICE IMPLICATIONS Heath coaching can be conducted in primary care clinics by nurses or advanced practice nurses. The short-term intervention tested here could be adapted to the clinical setting.
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Affiliation(s)
- Usha Menon
- College of Nursing, University of South Florida, Tampa, FL, USA.
| | - Laura A Szalacha
- College of Nursing, University of South Florida, Tampa, FL, USA; Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Glenn A Martinez
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Jose A Pares-Avila
- College of Nursing, University of South Florida, Tampa, FL, USA; College of Nursing, University of Arizona, Tucson, AZ, USA
| | | | - Leah S Stauber
- College of Nursing, University of Arizona, Tucson, AZ, USA
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Gupta S. Bridging patient-physician language barrier starts in medical school. Postgrad Med J 2022; 98:e189. [PMID: 34588296 DOI: 10.1136/postgradmedj-2021-140799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Sneha Gupta
- Faculty of Life Sciences and Medicine, King's College London, London, UK
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27
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Floridis J. Miscommunication and language-discordant care in Australian healthcare settings. Emerg Med Australas 2022; 34:278-279. [PMID: 35199467 DOI: 10.1111/1742-6723.13948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- John Floridis
- Department of Emergency Medicine and Perioperative Medicine, Gove District Hospital, Nhulunbuy, Northern Territory, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Patel P, Muscat DM, Trevena L, Zachariah D, Nosir H, Jesurasa N, Hadi A, Bernays S. Exploring the expectations, experiences and tensions of refugee patients and general practitioners in the quality of care in general practice. Health Expect 2021; 25:639-647. [PMID: 34951092 PMCID: PMC8957721 DOI: 10.1111/hex.13411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/16/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022] Open
Abstract
Background Refugees and asylum seekers arrive in the Australian community with complex health needs and expectations of healthcare systems formed from elsewhere. Navigating the primary healthcare system can be challenging with communication and language barriers. In multicultural societies, this obstacle may be removed by accessing language‐concordant care. Emerging evidence suggests language‐concordance is associated with more positive reports of patient experience. Whether this is true for refugees and asylum seekers and their expectation of markers of quality patient‐centred care (PCC) remains to be explored. This study aimed to explore the expectations around the markers of PCC and the impacts of having language‐concordant care in Australian primary healthcare. Methods We conducted semi‐structured individual in‐language (Arabic, Dari, and Tamil) remote interviews with 22 refugee and asylum seekers and 9 general practitioners (GPs). Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Results Community member expectations of markers of PCC are constantly evolving and adapting based on invisible and visible actions during clinical encounters. Challenges can occur in the clinical encounter when expectations are ‘unsaid’ or unarticulated by both community members and GPs due to the assumption of shared understanding with language concordant care. Expectations of what constitutes satisfactory, quality PCC are dynamic outcomes, which are influenced by prior and current experiences of healthcare. Conclusion This study highlights the importance of understanding that language concordant care does not always support aligned expectations of the markers of quality PCC between community members and their GP. We recommend that GPs encourage community members to provide explicit descriptions about how their prior experiences have framed their expectations of what characterizes quality PCC. In addition, GPs could develop a collaborative approach, in which they explain their own decision‐making processes in providing PCC to refugees and asylum seekers. Patient or Public Contribution Bilingual researchers from multicultural backgrounds and experience working with people from refugee backgrounds were consulted on study design and analysis. This study included individuals with lived experiences as refugees and asylum seekers and clinicians as participants.
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Affiliation(s)
- Pinika Patel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Danielle M Muscat
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lyndal Trevena
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ask Share Know: Rapid Evidence for General Practice Decisions (ASK-GP), Centre for Research Excellence, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Dipti Zachariah
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Hanaa Nosir
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Nishanthie Jesurasa
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Amina Hadi
- Multicultural Health, Integrated and Community Health Directorate, Western Sydney Local Health District, Cumberland, New South Wales, Australia
| | - Sarah Bernays
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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29
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Solchanyk D, Ekeh O, Saffran L, Burnett-Zeigler IE, Doobay-Persaud A. Integrating Cultural Humility into the Medical Education Curriculum: Strategies for Educators. TEACHING AND LEARNING IN MEDICINE 2021; 33:554-560. [PMID: 33573412 DOI: 10.1080/10401334.2021.1877711] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 12/01/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
ISSUE The framework of cultural humility, which emphasizes curiosity and self-reflection over mastery, was identified over 20 years ago as a way to address implicit bias in health care, an important factor in health disparities. Despite growing interest from researchers and educators, as well as the urgent call to adopt these values, the foundational elements of cultural humility remain challenging to teach in medical education and have not yet been widely adopted. EVIDENCE Health disparities persist throughout the United States among a growing population of diverse patients. The cultural humility framework undermines power imbalances by encouraging the clinician to view their patient as an expert of their own experience. This approach strengthens relationships within the community, illuminates racial and historical injustices, and contributes to equitable care. However, recent reviews have shown that humility-based principles have yet to be widely integrated into cultural curricula. Based on available evidence, this article introduces the foundational concepts of cultural humility with the aim of helping medical educators better understand and implement the principles of cultural humility into undergraduate medical education. IMPLICATIONS Cultural humility is a powerful and feasible adjunct to help student physicians cultivate effective tools to provide the best patient care possible to an increasingly diverse patient population. However, there is little known about how best to implement the principles of cultural humility into existing undergraduate medical education curricula. The analyses and strategies presented provide educators with the background, instructional and curricular methods to enable learners to cultivate cultural humility. Future systematic research will need to focus on investigating design, implementation and impact.
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Affiliation(s)
- Daniel Solchanyk
- Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Odera Ekeh
- Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lise Saffran
- Department of Public Health, University of Missouri, Columbia, Missouri, USA
| | - Inger E Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Ashti Doobay-Persaud
- Center for Global Health Education, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Hospital Medicine, Departments of Medicine and Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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30
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Himmelstein J, Himmelstein DU, Woolhandler S, Bor DH, Gaffney A, Zallman L, Dickman S, McCormick D. Health Care Spending And Use Among Hispanic Adults With And Without Limited English Proficiency, 1999-2018. Health Aff (Millwood) 2021; 40:1126-1134. [PMID: 34228521 DOI: 10.1377/hlthaff.2020.02510] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One in seven people in the US speak Spanish at home, and twenty-five million people in the US have limited English proficiency. Using nationally representative data from the Medical Expenditure Panel Survey, we compare health care spending for and health care use by Hispanics adults with limited English proficiency with spending for and use by English-proficient Hispanic and non-Hispanic adults. During 2014-18 mean annual per capita expenditures were $1,463 (35 percent) lower for Hispanic adults with limited English proficiency than for Hispanic adults who were English proficient, after adjustment for respondents' characteristics. Hispanic adults with limited English proficiency also made fewer outpatient and emergency department visits, had fewer inpatient days, and received fewer prescription medications than Hispanic adults who were English proficient. Health care spending gaps between Hispanic adults with limited English proficiency and non-Hispanic adults with English proficiency widened between 1999 and 2018. These language-based gaps in spending and use raise concern that language barriers may be obstructing access to care, resulting in underuse of medical services by adults with limited English proficiency.
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Affiliation(s)
- Jessica Himmelstein
- Jessica Himmelstein is a fellow in internal medicine, Cambridge Health Alliance, in Cambridge, Massachusetts
| | - David U Himmelstein
- David U. Himmelstein is a distinguished professor of public health at Hunter College, City University of New York, in New York, New York, and a lecturer in medicine at Cambridge Health Alliance/Harvard Medical School
| | - Steffie Woolhandler
- Steffie Woolhandler is a distinguished professor of public health at Hunter College, City University of New York, and a lecturer in medicine at Cambridge Health Alliance/Harvard Medical School
| | - David H Bor
- David H. Bor is a professor of medicine at Harvard Medical School, in Boston, Massachusetts, and chief academic officer at Cambridge Health Alliance
| | - Adam Gaffney
- Adam Gaffney is an assistant professor of medicine at Harvard Medical School and is in the Division of Pulmonary and Critical Care Medicine at Cambridge Health Alliance
| | - Leah Zallman
- Leah Zallman, who died in November 2020, was director of research at the Institute for Community Health, an assistant professor of medicine at Harvard Medical School, and a primary care physician at Cambridge Health Alliance, when this research was conducted
| | - Samuel Dickman
- Samuel Dickman is the medical director for primary care at Planned Parenthood South Texas, in San Antonio, Texas
| | - Danny McCormick
- Danny McCormick is an associate professor of medicine at Harvard Medical School and director of the Division of Social and Community Medicine in the Department of Medicine, Cambridge Health Alliance
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31
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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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The Effect of Javanese Language Videos with a Community Based Interactive Approach Method as an Educational Instrument for Knowledge, Perception, and Adherence amongst Tuberculosis Patients. PHARMACY 2021; 9:pharmacy9020086. [PMID: 33919615 PMCID: PMC8167738 DOI: 10.3390/pharmacy9020086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 12/25/2022] Open
Abstract
The long period of tuberculosis treatment causes patients to have a high risk of forgetting or stopping the medication altogether, which increases the risk of oral anti-tuberculosis drug resistance. The patient’s knowledge and perception of the disease affect the patient’s adherence to treatment. This research objective was to determine the impact of educational videos in the local language on the level of knowledge, perception, and adherence of tuberculosis patients in the Regional General Hospital (RSUD) Bangil. This quasi-experimental study design with a one-month follow-up allocated 62 respondents in the intervention group and 60 in the control group. The pre- and post-experiment levels of knowledge and perception were measured with a validated set of questions. Adherence was measured by pill counts. The results showed that the intervention increases the level of knowledge of the intervention group higher than that of the control group (p-value < 0.05) and remained high after one month of follow-up. The perceptions domains that changed after education using Javanese (Ngoko) language videos with the Community Based Interactive Approach (CBIA) method were the timeline, personal control, illness coherence, and emotional representations (p-value < 0.05). More than 95% of respondents in the intervention group take 95% of their pill compared to 58% of respondents in the control group (p-value < 0.05). Utilization of the local languages for design a community-based interactive approach to educate and communicate is important and effective.
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Balante J, Broek DVD, White K. How does culture influence work experience in a foreign country? An umbrella review of the cultural challenges faced by internationally educated nurses. Int J Nurs Stud 2021; 118:103930. [PMID: 33819641 DOI: 10.1016/j.ijnurstu.2021.103930] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Internationally educated nurses experience multidimensional challenges affecting their acculturation process in a foreign country. Cultural differences have been highlighted by research as a common barrier. There is a need to understand the cross-cultural challenges experienced by internationally educated nurses to promote a culturally inclusive workplace, particularly when these nurses practice in another country wherein cultural attitudes and beliefs are different from their own. OBJECTIVES To identify and synthesise the challenges to cultural values, beliefs, and practices of internationally educated nurses working in a foreign country. DESIGN An umbrella review was undertaken by synthesising evidence from systematic reviews. DATA SOURCES Databases searched were MEDLINE, Embase, PsychINFO, CINAHL and Scopus. Reviews published between 2000-2019 were considered. METHODS The review protocol was guided by the guidelines from the Joanna Briggs Institute. The Joanna Briggs Institute Critical Appraisal Instrument for Systematic Reviews and Research Syntheses was used to evaluate the methodological quality of the retrieved reviews. The extracted findings were tabulated, categorised into themes, and presented in a narrative synthesis. RESULTS Ten reviews met the inclusion criteria. These reviews examined the experiences of internationally educated nurses from different countries. The reviews highlighted that cultural differences had impacted the adaptation and professional experiences of internationally educated nurses. Four themes were identified: cultural differences lead to the feeling of being an outsider, intercultural communication issues transcend beyond fluency, differing nursing cultures complicate adaptation, and ethnic identity challenges work adjustment. CONCLUSIONS Despite having a great interest in the literature on the experiences and issues faced by internationally educated nurses, a distinct gap still exists. There is an absence of knowledge on the challenges experienced by internationally educated nurses concerning their cultural beliefs, values, and practices. Further work is needed to enhance understanding and to promote a culturally sensitive workplace.
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Affiliation(s)
- Jay Balante
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Level 6 - North, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.
| | - Diane van den Broek
- Discipline of Work and Organisational Studies, Business School, The University of Sydney, Corner Abercrombie Street and Codrington St, Darlington NSW 2006, Australia.
| | - Kate White
- Cancer Nursing Research Unit, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Level 6 - North, Chris O'Brien Lifehouse, Camperdown NSW 2050, Australia.
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Pereira JA, Hannibal K, Stecker J, Kasper J, Katz JN, Molina RL. Professional language use by alumni of the Harvard Medical School Medical Language Program. BMC MEDICAL EDUCATION 2020; 20:407. [PMID: 33158441 PMCID: PMC7648424 DOI: 10.1186/s12909-020-02323-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite the growing number of patients with limited English proficiency in the United States, not all medical schools offer medical language courses to train future physicians in practicing language-concordant care. Little is known about the long-term use of non-English languages among physicians who took language courses in medical school. We conducted a cross-sectional study to characterize the professional language use of Harvard Medical School (HMS) alumni who took a medical language course at HMS and identify opportunities to improve the HMS Medical Language Program. METHODS Between October and November 2019, we sent an electronic survey to 803 HMS alumni who took a medical language course at HMS between 1991 and 2019 and collected responses. The survey had questions about the language courses and language use in the professional setting. We analyzed the data using descriptive statistics and McNemar's test for comparing proportions with paired data. The study was determined not to constitute human subjects research. RESULTS The response rate was 26% (206/803). More than half of respondents (n = 118, 57%) cited their desire to use the language in their future careers as the motivation for taking the language courses. Twenty-eight (14%) respondents indicated a change from not proficient before taking the course to proficient at the time of survey whereas only one (0.5%) respondent changed from proficient to not proficient (McNemar's p-value < 0.0001). Respondents (n = 113, 56%) reported that clinical electives abroad influenced their cultural understanding of the local in-country population and their language proficiency. Only 13% (n = 27) of respondents have worked in a setting that required formal assessments of non-English language proficiency. CONCLUSIONS HMS alumni of the Medical Language Program reported improved language proficiency after the medical language courses' conclusion, suggesting that the courses may catalyze long-term language learning. We found that a majority of respondents reported that the medical language courses influenced their desire to work with individuals who spoke the language of the courses they took. Medical language courses may equip physicians to practice language-concordant care in their careers.
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Affiliation(s)
| | | | | | - Jennifer Kasper
- Department of Pediatrics and Global Health and Social Medicinem, Brigham and Women's Hospital, Boston, MA, USA
| | - Jeffrey N Katz
- Department of Medicine and Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Rose L Molina
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
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Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross-sectional study. Health Sci Rep 2020; 3:e2161. [PMID: 32318628 PMCID: PMC7170452 DOI: 10.1002/hsr2.161] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS United States Medical Licensing Exam (USMLE) scores are the single, most objective criteria for admission into residency programs in the country. Underrepresented minorities in medicine (URiM) are found to have lower USMLE scores compared to their White counterparts. The objective of this study is to examine how USMLE step 1 cutoff scores may exclude self-reported URiM from the residency interview process across various specialties. METHODS This was a retrospective cross-sectional study of 10 541 applicants to different residency programs at Zucker School of Medicine at Hofstra/Northwell Health between May 2014 and May 2015. We identified Blacks and Hispanics as URiM. The primary outcome is the percentage of applicants with USMLE step 1 score above different ranges of cutoff score, from 205 to 235 in five-point increments, by race/ethnicity and by URiM status. Secondary outcome is percentages of URiM vs non-URiM above and below mean USMLE step 1 scores by different specialties (internal medicine, obstetrics/gynecology, pediatrics, and psychiatry). RESULTS The study sample included 2707 White, 722 Black, 805 Hispanic, 5006 Asian, and 562 Other Race/Ethnicity applicants. Overall, 50.2% were male, 21.3% URiM, 7.4% had limited English proficiency, 67.6% attended international medical schools, and 2.4% are Alpha Omega Alpha Honor Medical Society (AOA) members. The mean (±SD) USMLE step 1 score was significantly greater among non-URiM applicants as compared to URiM applicants (223.7 ± 19.4 vs 216.1 ± 18.4, P < .01, two-sample t-test). Non-URiM applicants were younger, and the percentage of male and AOA applicants was greater among non-URiM applicants as compared to URiM applicants (50.5% vs 47.7%, P = .02, Chi-Square test; 2.9% vs 1.2%, P < .01, Chi-Square test, respectively). CONCLUSION Using a USMLE step 1 cutoff score as an initial filter for applicant recruitment and selection could jeopardize the benefits of a diverse residency program. Practical implications are discussed.
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Affiliation(s)
- Myia Williams
- Department of MedicineNorthwell HealthManhassetNew York
| | - Eun Ji Kim
- Department of MedicineNorthwell HealthManhassetNew York
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew York
- The Feinstein Institutes for Medical ResearchManhassetNew York
| | - Karalyn Pappas
- The Feinstein Institutes for Medical ResearchManhassetNew York
| | | | - Lyndonna Marrast
- Department of MedicineNorthwell HealthManhassetNew York
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew York
- The Feinstein Institutes for Medical ResearchManhassetNew York
| | - Renee Pekmezaris
- Department of MedicineNorthwell HealthManhassetNew York
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew York
- The Feinstein Institutes for Medical ResearchManhassetNew York
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