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Slade IR, Avery AD, Gonzalez C, Chung C, Qiu Q, Simpson YM, Ector C, Vavilala MS. Effective Use of Interpreter Services for Diverse Patients in a Safety-Net Hospital: Provider Perceptions of Barriers and Solutions. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00212-5. [PMID: 39183078 DOI: 10.1016/j.jcjq.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 07/02/2024] [Accepted: 07/15/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Culturally and linguistically diverse (CALD) patients should but do not routinely receive professional interpretation. The authors examined provider perceptions of barriers and solutions to interpreter services (IS) in a safety-net hospital to inform quality improvement (QI). METHODS A 13-item survey was distributed to 750 clinicians representing 10 services across professional roles, including social workers. Closed- and open-ended questions addressed accessing IS, IS value, and care for CALD patients. Respondents ranked eight barriers to routine IS use and provided ideas for improvement. Descriptive statistics characterized survey results in aggregate and by professional role and care team. Quantitative and qualitative results were triangulated for agreement between survey domains and coded free-text response themes. RESULTS A total of 221 responses were analyzed (29.5% response rate). Cost was the lowest-ranked barrier across roles. Leading barriers were efficiency pressures and cumbersome access. Free-text responses agreed with these findings. CALD patients were perceived to have higher complication risk by 87.5% of social workers but by 56.8% of other roles. Recommendations to increase IS varied by team: streamlined access process (46.2% emergency, 37.8% inpatient respondents), expanded in-person interpretation (55.6% inpatient, 45.8% perioperative respondents), and better equipment (44.4% outpatient, 35.9% emergency, 25.0% perioperative respondents). CONCLUSION Provider experiences vary by care team and interpretation modality. Interpretation services are cumbersome to access and compete with efficiency pressures, leading to shortcuts that fail to provide adequate language access. Three initial QI efforts resulted: increased video interpretation equipment, a new language access committee, and a new language access leadership role.
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Ennett S, Das A, Burcham M, Fitzgerald R, Boville B, Rajasekaran S, Kortz T, Leimanis‐Laurens ML. Linguistic isolation correlates with length of stay and mortality for pediatric oncology patients in California. Cancer Med 2024; 13:e7371. [PMID: 38967244 PMCID: PMC11224970 DOI: 10.1002/cam4.7371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVE To evaluate social drivers of health and how they impact pediatric oncology patients' clinical outcomes during pediatric intensive care unit (PICU) admission via correlation with patient ZIP codes. METHODS Demographic, clinical, and outcome variables from Virtual Pediatric Systems®, LLC for oncology patients (2009-2021) in California PICUs (excluding postoperative) using 3-digit ZIP Codes with social drivers of health variables linguistic isolation, poverty, race/ethnicity, and education abstracted from American Community Survey data for 3-digit ZIP Codes using the Environmental Protection Agency's EJScreen tool. Outcomes of length of stay (LOS), mortality, acuity scores, were compared with social variables. RESULTS Positive correlation between mortality and minority racial groups (Hispanic/Latino) across ZIP Codes (correlation coefficients of 0.45 (95% CI: 0.22-0.64, p < 0.001) in 2017, 0.50 (95% CI: 0.27-0.68, p < 0.001) in 2018, 0.33 (95% CI: 0.07-0.54, p = 0.013) in 2020, and 0.32 (95% CI: 0.06-0.53, p = 0.018) in 2021). Median PICU length of stay significantly correlated with linguistic isolation (coefficient of 0.42 (95% CI: 0.18-0.61, p = 0.001) in 2021 versus -0.41 (95% CI: -0.61 to -0.16, p = 0.002) in 2019), which included PRISMIII (n = 7417). Mixed effects logistic regression model for other constant variables (PRISMIII, cancer type, race/ethnicity, year), random effect of patient, linguistic isolation (percentage as a continuous value) was significantly associated (95% CI: 1.01-1.06; p = 0.02) with mortality; (OR = 1.03). CONCLUSIONS Linguistic isolation was correlated with LOS and mortality, however variable year to year.
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Affiliation(s)
| | - Akansha Das
- Washington & Jefferson CollegeWashingtonPennsylvaniaUSA
| | - Megan Burcham
- Pediatric Hematology Oncology, Helen DeVos Children's HospitalGrand RapidsMichiganUSA
| | - Robert Fitzgerald
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityGrand RapidsMichiganUSA
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
| | - Brian Boville
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityGrand RapidsMichiganUSA
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
| | - Surender Rajasekaran
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
- Department of Pediatrics, Division of Critical Care MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
- Office of Research, Corewell HealthGrand RapidsMichiganUSA
| | - Teresa Kortz
- Department of Pediatrics, Division of Critical Care MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Mara L. Leimanis‐Laurens
- Department of Pediatrics and Human Development, College of Human MedicineMichigan State UniversityGrand RapidsMichiganUSA
- Pediatric Intensive Care UnitHelen DeVos Children's HospitalGrand RapidsMichiganUSA
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Arya AN, Hyman I, Holland T, Beukeboom C, Tong CE, Talavlikar R, Eagan G. Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:588. [PMID: 38791802 PMCID: PMC11121150 DOI: 10.3390/ijerph21050588] [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: 01/17/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada's healthcare system.
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Affiliation(s)
- Akshaya Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 3L8, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
- Kitchener-Waterloo Centre for Family Medicine Refugee Health Clinic, Kitchener, ON N2G 1C5, Canada;
| | - Ilene Hyman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
| | - Tim Holland
- Department of Bioethics, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Newcomer Health Clinic, Halifax, NS B3L 4P1, Canada
| | - Carolyn Beukeboom
- Kitchener-Waterloo Centre for Family Medicine Refugee Health Clinic, Kitchener, ON N2G 1C5, Canada;
- Arthur Labatt Family School of Nursing, Western University, London, ON N6A 3K7, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Catherine E. Tong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Rachel Talavlikar
- Department of Family Medicine, University of Calgary, Calgary, AB T3H 0N9, Canada;
- Mosaic Refugee Health Clinic, Calgary, AB T2A 5H5, Canada
| | - Grace Eagan
- Language Services & Digital Strategy, Access Alliance Multicultural Health & Community Services, Toronto, ON M5T 3A9, Canada;
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Karliner LS, Gregorich SE, Mutha S, Kaplan C, Livaudais-Toman J, Pathak S, Garcia ME, Diamond L. Language Access Systems Improvement initiative: impact on professional interpreter utilisation, a natural experiment. BMJ Open 2024; 14:e073486. [PMID: 38176864 PMCID: PMC10773371 DOI: 10.1136/bmjopen-2023-073486] [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: 03/07/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the Language Access Systems Improvement (LASI) initiative's impact on professional interpreter utilisation in primary care and to explore patient and clinician perspectives on professional interpreter use. DESIGN Multi methods: Quantitative natural experiment pre-LASI and post-LASI, qualitative semistructured interviews with clinicians and focus groups with patients post-LASI. SETTING Large, academic primary care practice. PARTICIPANTS Cantonese, Mandarin, Spanish, English-speaking adult patients and their clinicians. INTERVENTION LASI initiative: Implementation of a clinician language proficiency test and simultaneous provision of on-demand access to professional interpreters via video medical interpretation. MAIN OUTCOME MEASURES Quantitative: Proportion of language discordant primary care visits which were professionally interpreted. Qualitative: Salient themes related to professional interpreter use and non-use. RESULTS The researchers categorised language concordance for 1475 visits with 152 unique clinicians; 698 were not fully language concordant (202 pre-LASI and 496 post-LASI). Professional interpreter utilisation increased (pre-LASI 57% vs post-LASI 66%; p=0.01); the visits with the lowest percentage of profssional interpreter use post-LASI were those in which clinicians and patients had partial language concordance. In inverse probability weighted analysis, restricting to 499 visits with strict estimated propensity score overlap (100% common support), post-LASI visits had higher odds of using a professional interpreter compared with pre-LASI visits (OR 2.39; 95% CI 1.04 to 5.48). Qualitative results demonstrate video interpretation was convenient and well liked by both clinicians and patients. Some partially bilingual clinicians reported frustration with patient refusal of interpreter services; others reported using the video interpreters as a backup during visits. Views of the care-partner role differed for clinicians and patients. Clinicians reported sometimes having family interpret out of convenience or habit, whereas patients reported wanting family members present for support and advocacy, not interpretation. CONCLUSIONS LASI increased utilisation of professional interpreters; however, this was least prominent for partially language concordant visits. Health systems wishing to implement LASI or similar interventions will need to support clinicians and patients with partial bilingual skills in their efforts to use professional interpreters. TRIAL REGISTRATION NUMBER HSRP20153367.
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Affiliation(s)
| | | | - Sunita Mutha
- University of California, San Francisco, California, USA
| | - Celia Kaplan
- University of California, San Francisco, California, USA
| | | | | | - Maria E Garcia
- University of California, San Francisco, California, USA
| | - Lisa Diamond
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Benda NC, Wesley DB, Nare M, Fong A, Ratwani RM, Kellogg KM. Social Determinants of Health and Patient Safety: An Analysis of Patient Safety Event Reports Related to Limited English-Proficient Patients. J Patient Saf 2022; 18:e1-e9. [PMID: 32168283 DOI: 10.1097/pts.0000000000000663] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial and ethnic disparities in healthcare safety have persisted for decades, particularly for patients with language barriers. Previous studies have investigated the frequency and nature of safety events impacting patients with language barriers; others have proposed solutions to fix them. A gap analysis, however, of how we are currently addressing safety issues and why these efforts have not been effective is lacking. METHOD This analysis uses reports from a patient safety event reporting system. Reports contain information regarding no-harm (near miss) events and events where harm may have reached the patient. Reports occurring with patients with a preferred language other than English were extracted and analyzed to determine whether the language barrier contributed to the safety event, the language barrier was mentioned in the resolution, and themes were mentioned for addressing language barriers. RESULTS A subset of 1553 events pertaining to non-English-speaking patients were first categorized as "likely" (3%), "plausibly" (10%), or "unlikely" (87%) related to the patient's language barrier. Second, events related to the patient's language barrier were categorized as directly addressing (19%), indirectly addressing (3%), not mentioning (69%) the language barrier, or containing insufficient information to determine whether the language barrier was addressed (7%). Third, thematic analysis revealed that the most common methods for addressing language barriers included presenting issues to interpreter services and subsequent use of interpreter services. CONCLUSIONS This study found that it is challenging to determine the direct role of certain social determinants of health (e.g., language barriers) in safety events. In many cases, the language barrier was not addressed in the event report. Furthermore, when the language barrier was addressed, solution themes typically involved weaker, less sustainable suggested actions.
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Affiliation(s)
| | | | - Matthew Nare
- Department of Psychology, California State, Long Beach, California
| | - Allan Fong
- From the National Center for Human Factors in Healthcare, MedStar Health, Washington, District of Columbia
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Zhang D, Rajbhandari-Thapa J, Panda S, Chen Z, Shi L, Li Y, Shen Y, Ghimire R, Emerson KG. Linguistic Isolation and Mortality in Older Mexican Americans: Findings from the Hispanic Established Populations Epidemiologic Studies of the Elderly. Health Equity 2021; 5:375-381. [PMID: 34095708 PMCID: PMC8175265 DOI: 10.1089/heq.2020.0139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 11/12/2022] Open
Abstract
Purpose: Limited English proficiency and increased language isolation are known to be associated with adverse health outcomes. It is not clear how neighborhood-level linguistic isolation may impact individual health and risk of death among Hispanic older adults. We examined the link between living in a linguistically isolated neighborhood and all-cause mortality among an older Mexican American cohort. Methods: Using a longitudinal sample of older Mexican Americans from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly, we calculated the days from the baseline interview (1993–1994) until observed death through five waves of follow-up (until 2004–2005) using Cox regression. A linguistically isolated neighborhood was defined as a census tract with more than 30% of linguistically isolated households. Results: Our results showed that living in a neighborhood with more than 30% of linguistically isolated households predicted higher mortality (hazard ratio: 1.25; 95% confidence interval: 1.04–1.50), after adjusting for age, sex, nativity, years of education, marital status, self-reported health status, number of chronic conditions, ever smoked, ever drank, and other neighborhood-level contextual factors. Conclusion: Living in a neighborhood with a high proportion of linguistically isolated households predicted higher mortality among older Mexican Americans. Addressing the social capital shortage in linguistically isolated neighborhoods is one way to address health disparities in the United States.
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Affiliation(s)
- Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Saswat Panda
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Yan Li
- Department of Population Health Science and Policy, Gynecology, and Reproductive Science (Secondary), Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Department of Obstetrics, Gynecology, and Reproductive Science (Secondary), Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ye Shen
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA
| | | | - Kerstin Gerst Emerson
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
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Mirza M, Harrison EA, Miller KA, Jacobs EA. Indicators of Quality Rehabilitation Services for Individuals with Limited English Proficiency: A 3-Round Delphi Study. Arch Phys Med Rehabil 2021; 102:2125-2133. [PMID: 34052214 DOI: 10.1016/j.apmr.2021.04.020] [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: 01/24/2021] [Revised: 04/09/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To obtain expert consensus on indicators of quality rehabilitation services for individuals with limited English proficiency (LEP). DESIGN Three-round Delphi study. SETTING Delphi survey conducted online with 30 experts. Most experts worked in adult physical rehabilitation settings and were from Illinois (n=16), and the remaining participants were from 8 other US states or Canadian provinces. PARTICIPANTS Experts (N=30) had a minimum of 2 publications on health care services for patients with LEP and/or a minimum of 5 years clinical experience in physical rehabilitation. Of 43 experts (11 researchers, 32 clinicians) who received the round 1 survey by e-mail, 30 returned complete responses (70% response rate). Of those, 25 completed round 2 and 24 completed round 3. Of round 1 participants, most (n =21) identified their primary professional activity as clinical, whereas the others worked in research (n =5) or education (n =4). Twenty-four were women. The median age was 43 years (range, 27-67y). Disciplines included occupational therapy (n =14), physical therapy (n =13), psychology (n=1), nursing (n=1), and medicine (n=1). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Indicators were rated on a 7-point Likert scale for importance and feasibility. Interquartile range (IQR) and 95% confidence intervals were calculated for importance and feasibility ratings. Indicators with an IQR <2 and a median importance score ≥6 were accepted as reaching consensus for importance. RESULTS Round 1 responses were categorized into 15 structural, 13 process, and 18 outcome indicators. All 15 structural indicators reached consensus for importance; 8 were rated as feasible. All 13 process indicators reached consensus, of which 8 were deemed feasible. Sixteen outcome indicators reached consensus, of which 7 were deemed feasible. CONCLUSIONS This Delphi study identified structural, process, and outcome indicators that can inform delivery and assessment of quality rehabilitation services for individuals with LEP. Future research should operationalize and measure these quality indicators in clinical practice.
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Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL.
| | - Elizabeth A Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL
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Turin TC, Rashid R, Ferdous M, Naeem I, Rumana N, Rahman A, Rahman N, Lasker M. Perceived barriers and primary care access experiences among immigrant Bangladeshi men in Canada. Fam Med Community Health 2020; 8:e000453. [PMID: 32994217 PMCID: PMC7526305 DOI: 10.1136/fmch-2020-000453] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE The study aimed to explore the experience of male members of a rapidly grown community of Bangladeshi immigrants while accessing primary healthcare (PHC) services in Canada. DESIGN A qualitative research was conducted among a sample of Bangladeshi immigrant men through a community-based participatory research approach. Focus group discussions were conducted to collect the qualitative data where thematic analysis was applied. SETTING The focus group discussions were held in various community centres such as individual meeting rooms at public libraries, community halls and so on arranged in collaboration with community organisations while ensuring complete privacy. PARTICIPANT Thirty-eight adults, Bangladeshi immigrant men, living in Calgary were selected for this study and participated in six different focus groups. The sample represents mostly married, educated, Muslim, Bangla speaking, aged over 25 years, full-time or self-employed and living in an urban centre in Canada >5 years. RESULT The focus groups have highlighted long wait time as an important barrier. Long wait at the emergency room, difficulties to get access to general physicians when feeling sick, slow referral process and long wait at the clinic even after making an appointment impact their daily chores, work and access to care. Language is another important barrier that impedes effective communication between physicians and immigrant patients, thus the quality of care. Unfamiliarity with the healthcare system and lack of resources were also voiced that hinder access to healthcare for immigrant Bangladeshi men in Canada. However, no gender-specific barriers unique to men have been identified in this study. CONCLUSION The barriers to accessing PHC services for Bangladeshi immigrant men are similar to that of other visible minority immigrants. It is important to recognise the extent of barriers across various immigrant groups to effectively shape public policy and improve access to PHC.
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Affiliation(s)
- Tanvir C Turin
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ruksana Rashid
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mahzabin Ferdous
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Iffat Naeem
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nahid Rumana
- Sleep Center, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Afsana Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Nafiza Rahman
- Community Based Citizen Researcher, Calgary, Alberta, Canada
| | - Mohammad Lasker
- Community Based Citizen Researcher, Calgary, Alberta, Canada
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Benda NC, Fairbanks RJ, Higginbotham DJ, Lin L, Bisantz AM. Observational study to understand interpreter service use in emergency medicine: why the key may lie outside of the initial provider assessment. Emerg Med J 2019; 36:582-588. [DOI: 10.1136/emermed-2019-208420] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/17/2019] [Accepted: 06/28/2019] [Indexed: 11/03/2022]
Abstract
ObjectiveTo characterise the use of interpreter services and other strategies used to communicate with limited English proficient (LEP) patients throughout their emergency department visit.MethodsWe performed a process tracing study observing LEP patients throughout their stay in the emergency department. A single observer completed 47 hours of observation of 103 communication episodes between staff and nine patients with LEP documenting the strategy used to communicate (eg, professional interpreter, family member, own language skills) and duration of conversations for each communicative encounter with hospital staff members. Data collection occurred in a single emergency department in the eastern USA between July 2017 and February 2018.ResultsThe most common strategy (per communicative encounter) was for the emergency department staff to communicate with the patient in English (observed in 29.1% of encounters). Total time spent in communicating was highest using telephone-based interpreters (32.9% of total time spent communicating) and in-person interpreters (29.2% of total time spent communicating). Communicative mechanism also varied by care task/phase of care with the most use of interpreter services or Spanish proficient staff (as primary communicator) occurring during triage (100%) and the initial provider assessment (100%) and the lowest interpreter service use during ongoing evaluation and treatment tasks (24.3%).ConclusionsEmergency department staff use various mechanisms to communicate with LEP patients throughout their length of stay. Utilisation of interpreter services was poorest during evaluation and treatment tasks, indicating that this area should be a focus for improving communication with LEP patients.
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Taira BR, Kim K, Mody N. Hospital and Health System-Level Interventions to Improve Care for Limited English Proficiency Patients: A Systematic Review. Jt Comm J Qual Patient Saf 2019; 45:446-458. [PMID: 30910471 DOI: 10.1016/j.jcjq.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although federal legislation mandates the provision of qualified interpreters for limited English proficiency (LEP) patients, language services are consistently underutilized by health care providers even when readily available. The objective of this study was to systematically review the literature and summarize evidence for interventions at the hospital or health system level that improve communication with, quality of care for, or health outcomes of LEP patients. METHODS The literature was systematically reviewed according to PRISMA guidelines to answer the following question: "For patients with limited English proficiency, which interventions at the hospital or health system level will result in improved communication, quality of care, or health outcomes?" RESULTS The search yielded an initial 16,686 references, 19 of which met the inclusion criteria. Baseline rates of language service utilization were extremely low and remained at low levels postintervention in multiple studies. Most studies focused on language service utilization, patient communication, metric tracking, and access to care, whereas few studies evaluated quality of care or health outcomes of LEP patients. Multifaceted interventions that include elements of administrative emphasis, process evaluation, and education appear to improve language service use and communication. CONCLUSION This review revealed large gaps in the evidence to guide hospital and health system improvement strategies for LEP patient care. Given the large and persistent performance gaps in the provision of language assistance for LEP patients, hospitals, health systems, and granting agencies should invest in implementation and dissemination research focused on language service use.
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Telephone Interpreting in Home Postpartum Care of Allophone Migrant Women by Midwives / Telefondolmetschen in der geburtshilflichen Nachbetreuung von fremdsprachigen Migrantinnen durch Hebammen zu Hause. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2019. [DOI: 10.2478/ijhp-2019-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Perinatal health disadvantage of migrants is exacerbated in presence of language barriers. Interpreting has the potential to optimize both, communication and outcome of mother and child. In Switzerland, a regional midwifery network provides access to telephone interpreting services although it is not remunerated by health insurances, and thus, is often impeded. This study examined usefulness, areas of use and difficulties of telephone interpreting in home postpartum care by midwives.
Data was collected between September 2013 and March 2016 by midwives of the network. The questionnaire contained multiplechoice questions, a visual analogue scale and free-text fields.
46 questionnaires were evaluated. 10 out of 29 specially trained midwives exerted the service. Telephone interpreting was primarily used to record women’s concerns and provide information. The main topics were the somatic health of mother and child, breastfeeding, and more rarely psychosocial issues and information on care provision. Achieved understanding, increased women’s satisfaction and improved health competence were the perceived advantages in using the service. Difficulties, especially with the extra time needed for the consultation, insufficient telephone connection and professionality of the telephone interpreter, were stated less often. Overall, the midwives estimated the benefits of telephone interpreting for the quality of care with 7.4 out of 10 possible points.
Although telephone interpreting improved the quality of care, midwives did infrequently use it. Specific training and video interpreting have the potential to increase the quality of the interpreted conversations and to minimize possible hurdles. Psychosocial issues should be addressed more intensively.
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Osae-Larbi JA. Bridging the language barrier gap in the health of multicultural societies: report of a proposed mobile phone-based intervention using Ghana as an example. SPRINGERPLUS 2016. [PMCID: PMC4923006 DOI: 10.1186/s40064-016-2602-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Across the globe, societies are recording an increasing number of domestic and international migrants for numerous reasons. While this may promote multiculturalism, new migrants and linguistically minority ethnocultural groups may face challenges in fully and equitably participating in various aspects of broader societies, due to language barriers. The purpose of this paper is to propose the use of Unstructured Supplementary Service Data (USSD) codes as an innovative intervention to address this long standing issue of language barriers, specifically as it pertains to accessing pertinent health information in multicultural societies. The USSD is a protocol that allows two-way communication between mobile phones and service providers, and which can be used independent of internet access. By dialing specific USSD codes (e.g. *555#) on their mobile phones, the proposed intervention would enable culturally and linguistically diverse populations in Ghana to access pertinent health information, particularly preventive information in understood language options on their phones. Using the current state of multiculturalism in Ghana as an example, this paper also describes how the proposed intervention can be developed, implemented and evaluated. The paper concludes by highlighting the significance of the proposed intervention to multiculturalism in Ghana and the implications for research. Bridging language barriers in access to health information is central to promoting the health of multicultural societies and fostering multicultural relationships. Therefore, overall, it is expected that this paper would stimulate thinking and research into innovative approaches that may help to successfully bridge language barriers in the area of health of multicultural societies.
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