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Lion KC, Zhou C, Fishman P, Senturia K, Cole A, Sherr K, Opel DJ, Stout J, Hazim CE, Warren L, Rains BH, Lewis CC. A sequential, multiple assignment randomized trial comparing web-based education to mobile video interpreter access for improving provider interpreter use in primary care clinics: the mVOCAL hybrid type 3 study protocol. Implement Sci 2023; 18:8. [PMID: 36915138 PMCID: PMC10012737 DOI: 10.1186/s13012-023-01263-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/12/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Individuals who use a language other than English for medical care are at risk for disparities related to healthcare safety, patient-centered care, and quality. Professional interpreter use decreases these disparities but remains underutilized, despite widespread access and legal mandates. In this study, we compare two discrete implementation strategies for improving interpreter use: (1) enhanced education targeting intrapersonal barriers to use delivered in a scalable format (interactive web-based educational modules) and (2) a strategy targeting system barriers to use in which mobile video interpreting is enabled on providers' own mobile devices. METHODS We will conduct a type 3 hybrid implementation-effectiveness study in 3-5 primary care organizations, using a sequential multiple assignment randomized trial (SMART) design. Our primary implementation outcome is interpreter use, calculated by matching clinic visits to interpreter invoices. Our secondary effectiveness outcome is patient comprehension, determined by comparing patient-reported to provider-documented visit diagnosis. Enrolled providers (n = 55) will be randomized to mobile video interpreting or educational modules, plus standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative strategy. After another 9 months, both strategies will be available to enrolled providers for 9 more months. Providers will complete 2 surveys (beginning and end) and 3 in-depth interviews (beginning, middle, and end) to understand barriers to interpreter use, based on the Theoretical Domains Framework. Patients who use a language other than English will be surveyed (n = 648) and interviewed (n = 75) following visits with enrolled providers to understand their experiences with communication. Visits will be video recorded (n = 100) to assess fidelity to assigned strategies. We will explore strategy mechanism activation to refine causal pathway models using a quantitative plus qualitative approach. We will also determine the incremental cost-effectiveness of each implementation strategy from a healthcare organization perspective, using administrative and provider survey data. DISCUSSION Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, the mechanisms by which they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities. TRIAL REGISTRATION NCT05591586.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA.
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, 98145-5005, USA
| | - Paul Fishman
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Kirsten Senturia
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, WA, USA
| | - Douglas J Opel
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - James Stout
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carmen E Hazim
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
| | - Louise Warren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Bonnie H Rains
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cara C Lewis
- Department of Global Health, University of Washington Schools of Medicine and Public Health, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Stephen JM, Zoucha R, Cazzell M, Devido J. Cultural care needs of Spanish speaking parents with limited English proficiency whose children are hospitalized: An ethnonursing study. J Pediatr Nurs 2023; 69:62-70. [PMID: 36669293 DOI: 10.1016/j.pedn.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE Parents' inability to speak English proficiently is associated with communication barriers in the care process of their children, social determinants of health, and poor child health outcomes. Research exploring perspectives of Spanish speaking parents with limited English proficiency (SSP-LEP) whose children are hospitalized in the context of culture is lacking in the literature. The purpose of this study was to explore the cultural experiences, values, and beliefs of SSP-LEP, of Mexican origin, whose children were hospitalized and to understand nurses' roles in providing culturally congruent care. DESIGN AND METHODS Leininger's qualitative, ethnonursing method was used for this study. The Theory of Culture Care Diversity and Universality provided a guiding framework. Eleven SSP-LEP, of Mexican origin, participated in interviews conducted in-person and via Zoom. Data was analyzed using Leininger's four phases of qualitative analysis. RESULTS Three themes emerged: 1. role of the mother as an ever-present manager of care for the hospitalized child and family, 2. parents' difficult, fearful, stressful, and unknowing experiences in the presence of a language barrier, and 3. expected nursing care that was kind, respectful, compassionate, and attentive. CONCLUSIONS Lack of knowledge creates hardships for parents who desire to be involved, informed caregivers. Communication in Spanish language is integral to parents' understanding and expected nursing care. SSP-LEP may have negative feelings; yet describe a positive care experience. PRACTICE IMPLICATIONS Culturally congruent care should incorporate language services for information sharing that facilitates parent participation and decision-making; be kind, respectful, compassionate, and attentive; and promote maternal role maintenance.
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Affiliation(s)
| | - Rick Zoucha
- Advanced Role and PhD Programs, Duquesne University, 600 Forbes Avenue, 527 Fisher Hall, Pittsburgh, PA 15202, USA.
| | - Mary Cazzell
- Nursing Research and Evidence-Based Practice, Cook Children's Medical Center, 801 Seventh Avenue, Fort Worth, TX 76104, USA.
| | - Jessica Devido
- Duquesne University, 600 Forbes Avenue, 519 Fisher Hall, Pittsburgh, PA 15202, USA.
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Stephen JM, Zoucha R. Spanish Speaking, Limited English Proficient Parents whose Children are Hospitalized: An Integrative Review. J Pediatr Nurs 2020; 52:30-40. [PMID: 32163844 DOI: 10.1016/j.pedn.2020.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
PROBLEM Children of non-English speakers are at risk for health disparities. Little is known about the experiences of Spanish speaking parents with limited English proficiency (LEP) whose children are hospitalized. The purposes of this integrative review were to explore what is known and to identify gaps in the literature about the experiences of Spanish speaking parents with LEP whose children are hospitalized. ELIGIBILITY CRITERIA Whittemore and Knafl's (2005) integrative review method guided the process. Studies addressed Spanish speaking parents of hospitalized children in the United States. SAMPLE A final sample consisted of 36 quantitative and qualitative research studies published from 1994 to 2018; located through a search of CINAHL, Pubmed, and Scopus. RESULTS Language services were inconsistent although mandated by standards and laws. Parents experienced mixed emotions related to care. Emergency departments in large, urban cities were the most common care settings. Differences in care outcomes and safety risks for children of Spanish speaking parents existed; however, findings were inconsistent. Only three of the 36 studies addressed nursing care. CONCLUSIONS Research design and quality varied. Parents valued communication in their language. Nurses are the primary healthcare provider in the hospital setting but few studies explored parents' experiences associated with nursing care. No studies explored parents' experiences with their child's hospitalization in the context of culture. IMPLICATIONS Future research is needed to explore the cultural values, beliefs, and experiences of Spanish speaking parents with LEP and the role of nurses and to inform culturally congruent nursing care, research, and policy.
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Lion KC, Zhou C, Ebel BE, Penfold RB, Mangione-Smith R. Identifying Modifiable Health Care Barriers to Improve Health Equity for Hospitalized Children. Hosp Pediatr 2020; 10:1-11. [PMID: 31801795 PMCID: PMC6931033 DOI: 10.1542/hpeds.2019-0096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children from socially disadvantaged families experience worse hospital outcomes compared with other children. We sought to identify modifiable barriers to care to target for intervention. METHODS We conducted a prospective cohort study of hospitalized children over 15 months. Caregivers completed a survey within 3 days of admission and 2 to 8 weeks after discharge to assess 10 reported barriers to care related to their interactions within the health care system (eg, not feeling like they have sufficient skills to navigate the system and experiencing marginalization). Associations between barriers and outcomes (30-day readmissions and length of stay) were assessed by using multivariable regression. Barriers associated with worse outcomes were then tested for associations with a cumulative social disadvantage score based on 5 family sociodemographic characteristics (eg, low income). RESULTS Of eligible families, 61% (n = 3651) completed the admission survey; of those, 48% (n = 1734) completed follow-up. Nine of 10 barriers were associated with at least 1 worse hospital outcome. Of those, 4 were also positively associated with cumulative social disadvantage: perceiving the system as a barrier (adjusted β = 1.66; 95% confidence interval [CI] 1.02 to 2.30), skill barriers (β = 3.82; 95% CI 3.22 to 4.43), cultural distance (β = 1.75; 95% CI 1.36 to 2.15), and marginalization (β = .71; 95% CI 0.30 to 1.11). Low income had the most consistently strong association with reported barriers. CONCLUSIONS System barriers, skill barriers, cultural distance, and marginalization were significantly associated with both worse hospital outcomes and social disadvantage, suggesting these are promising targets for intervention to decrease disparities for hospitalized children.
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Affiliation(s)
- K Casey Lion
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
| | - Chuan Zhou
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
| | - Beth E Ebel
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington
| | - Robert B Penfold
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Rita Mangione-Smith
- Department of Pediatrics and
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington; and
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Choe AY, Unaka NI, Schondelmeyer AC, Bignall WJR, Vilvens HL, Thomson JE. Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children. J Hosp Med 2019; 14:607-613. [PMID: 31339836 PMCID: PMC6817305 DOI: 10.12788/jhm.3240] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Achieving effective communication between medical providers and families with limited English proficiency (LEP) in the hospital is difficult. OBJECTIVE Our objective was to identify barriers to and drivers of effective interpreter service use when caring for hospitalized LEP children from the perspectives of pediatric medical providers and interpreters. DESIGN/PARTICIPANTS/SETTING We used Group Level Assessment (GLA), a structured qualitative participatory method that allows participants to directly produce and analyze data in an interactive group session. Participants from a single academic children's hospital generated individual responses to prompts and identified themes and relevant action items. Themes were further consolidated by our research team and verified by stakeholder groups. RESULTS Four GLA sessions were conducted including 64 participants: hospital medicine physicians and pediatric residents (56%), inpatient nursing staff (16%), and interpreter services staff (28%). Barriers identified included: (1) difficulties accessing interpreter services; (2) uncertainty in communication with LEP families; (3) unclear and inconsistent expectations and roles of team members; and (4) unmet family engagement expectations. Drivers of effective communication were: (1) utilizing a team-based approach between medical providers and interpreters; (2) understanding the role of cultural context in providing culturally effective care; (3) practicing empathy for patients and families; and (4) using effective family-centered communication strategies. CONCLUSIONS Participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. Future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
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Affiliation(s)
- Angela Y Choe
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Corresponding Author: Angela Y. Choe, MD; E-mail: ; Telephone: 513-636-3893; Twitter: @AChoeMD
| | - Ndidi I Unaka
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda C Schondelmeyer
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Whitney J Raglin Bignall
- Division of Psychology in the Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Heather L Vilvens
- Allied Health Department, University of Cincinnati Blue Ash College, Cincinnati, Ohio
| | - Joanna E Thomson
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Platter E, Hamline MY, Tancredi DJ, Fernandez Y Garcia E, Rosenthal JL. Completeness of Written Discharge Guidance for English- and Spanish-Speaking Patient Families. Hosp Pediatr 2019; 9:516-522. [PMID: 31182648 DOI: 10.1542/hpeds.2018-0250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Written discharge guidance for hospitalized pediatric patients should include language-appropriate key elements to ensure positive discharge outcomes. Our objective in this study was to determine the completeness of written pediatric discharge guidance and to test the hypothesis that Spanish-speaking families with limited English proficiency (LEP) receive less complete written discharge guidance than English-speaking families. METHODS We conducted a retrospective review of written discharge guidance provided to 100 English- and 100 Spanish-speaking families at an urban nonfreestanding children's hospital to assess the inclusion of key elements: follow-up plan, contingency plan, telephone contact, discharge medications, discharge diagnosis, and hospital course. We compared the completeness of discharge guidance (number of elements provided among number of applicable elements) between English- versus Spanish-speaking families. RESULTS When evaluating discharge guidance for the presence of key elements in any language, there was no significant difference between English- and Spanish-speaking families. However, the mean completeness of language-appropriate discharge guidance for English- and Spanish-speaking families was 87.8% (95% confidence interval [CI] 84.4%-91.1%) and 16.0% (95% CI 11.5%-20.4%), respectively. The ordinal logistic regression examining the association between the number of key element deficits and English- (reference group) versus Spanish-speaking families demonstrated an adjusted odds ratio of 339.8 (95% CI 112.4-1027.5). CONCLUSIONS Few Spanish-speaking families with LEP receive written discharge guidance in their preferred language. Complete, language-appropriate discharge guidance was identified as an area for improvement efforts to work toward improving care provided to families with LEP.
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Affiliation(s)
- Erin Platter
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia; and
| | - Michelle Y Hamline
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Sacramento, California
| | | | - Jennifer L Rosenthal
- Department of Pediatrics, University of California, Davis, Sacramento, California
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