A Systematic Review of Interventions to Address Accent-Related Communication Problems in Healthcare

Effectiveness of Intense Accent Modification Training With Refugees From Burma

PURPOSE

This pilot research project sought to determine if an intensive accent modification training program that included See the Sound-Visual Phonics and prosodic gestures improved articulation, prosody, and intelligibility measures in refugees from Burma.

PARTICIPANTS

Four individuals (two men, two women) aged 20-67 participated in this study, and they were recruited from a state organization supporting refugees who have resettled in the United States.

METHOD

All participants completed the Proficiency in Oral English Communication (POEC) and Assessment of Intelligibility of Dysarthric Speech (AIDS) to measure pre- and posttraining changes. The duration of this study was 6 weeks and consisted of 1 week of pretesting, 4 weeks of accent modification training, and 1 week of posttesting. Participants attended a total of twelve 50-min accent modification training sessions, including eight individual sessions (twice per week) and four group sessions (once per week), which provided a functional way to practice newly acquired skills in a scripted conversational-type format. Trained and untrained articulation and prosody probes were used to establish baselines and measure change.

RESULTS

All four participants showed gains across articulation and prosody (in untrained and trained items). On pre- and posttest measures, three of the four participants also made gains on the broad measures of the AIDS and the POEC.

CONCLUSION

Findings support that a brief and intensive multimodality accent modification program can be beneficial.

Cascade screening for beta-thalassaemia in Pakistan: relatives' experiences of a decision support intervention in routine practice

Low uptake of cascade screening for βeta-thalassaemia major (β-TM) in the 'Punjab Thalassaemia Prevention Project' (PTPP) in Pakistan led to the development of a 'decision support intervention for relatives' (DeSIRe). This paper presents the experiences of relatives of children with β-TM of the DeSIRe following its use by PTPP field officers (FOs) in routine clinical practice. Fifty-four semi-structured qualitative interviews were conducted (April to June 2021) with relatives in seven cities in the Punjab province (Lahore, Sheikhupura, Nankana Sahab, Kasur, Gujranwala, Multan and Faisalabad). Thematic analysis shows that participants were satisfied with the content of the DeSIRe and its delivery by the FOs in a family meeting. They understood that the main purpose of the DeSIRe was to improve their knowledge of β-TM and its inheritance, and to enable them to make decisions about thalassaemia carrier testing, particularly before marriage. Participants also raised concerns about the stigma of testing positive; however, they believed the DeSIRe was an appropriate intervention, which supported relatives to make informed decisions. Our findings show that the DeSIRe is appropriate for use by healthcare professionals in routine practice in a low-middle income country, and has the potential to facilitate shared decision making about cascade screening for thalassaemia. Further research is needed to prove the efficacy of the DeSIRe.

Linguistic barriers and healthcare in China: Chaoshan vs. Mandarin

BACKGROUND

China has 129 dialects with Mandarin as the standard and Chaoshan as the major dialect of the Chaoshan region in Guangdong. This study aimed to describe the dialect competence and usage, communication difficulty, impact of linguistic barriers, and subjective experience in healthcare.

METHODS

Healthcare providers (n = 234) and healthcare consumers (n = 483) at two tertiary teaching hospitals in Shantou, Chaoshan region participated in an anonymous survey.

RESULTS

Chaoshan and Mandarin were spoken respectively by ca. 80% and 6.1% of the participants. Monolinguals accounted for 28.5%, including 16.8% of Chaoshan-speaking healthcare providers and 18% of Mandarin-speaking healthcare consumers. The monolinguals preferentially used their competent dialect (Ps < 0.001) and had significant communication difficulties (Ps < 0.0001), with the mean (SD) score of 3.06 (0.96) out of 4 with Mandarin for healthcare providers and 2.18 (1.78) and 1.64 (1.40) with Mandarin and Chaoshan, respectively, for healthcare consumers. The monolingual healthcare providers perceived significant negative impacts of linguistic barriers on the entire healthcare delivery process (Ps < 0.0001). Regression analyses showed the length of stay in the Chaoshan region as a protective factor of linguistic barrier with a limited protective effect.

CONCLUSIONS

This is the first report of significant linguistic barriers in healthcare imposed by Mandarin and Chaoshan dialects in Chaoshan, China. With perceived adverse impacts on the entire healthcare delivery and risks to the healthcare quality and burden, interventions such as professional interpreter service, service-learning interpreter program, or mobile interpreting apps that are medically accurate and culturally sensitive are suggested for dialectally diverse China.

A Viewpoint on Accent Services: Framing and Terminology Matter

PURPOSE

The purpose of this article is to offer a contemporary viewpoint on accent services and contend that an equity-minded reframing of accent services in speech-language pathology is long overdue. Such reframing should address directly the use of nonpejorative terminology and the need for nurturing global linguistic diversity and practitioner diversity in speech-language pathology. The authors offer their perspective on affirmative and least-biased accent services, an in-depth scoping review of the literature on accent modification, and discuss using terms that communicate unconditional respect for speaker identity and an understanding of the impact of accent services on accented speakers.

CONCLUSIONS

Given ongoing discussions about the urgent need to diversify the profession of speech-language pathology, critical attention is needed toward existing biases toward accented speakers and how such biases manifest in the way that accent services are provided as well as in how clinicians conceptualize their role in working with accented speakers. The authors conclude with discussing alternate terms and offer recommendations for accent services provided by speech-language pathologists.

Using a Foreign Language Changes Medical Judgments of Preventative Care

Every day, multilinguals around the world make important healthcare decisions while using a foreign language. The present study examined how the use of a native vs. non-native language shapes evaluations and decisions about preventative care. Bilinguals were randomly assigned to evaluate a series of medical scenarios in either their native or non-native language. Each scenario described potential adverse effects of a medical condition and a preventative treatment, as well as the population risk of disease- or treatment-related complications. Participants judged the perceived negativity and likelihood of experiencing adverse effects and indicated how willing they would be to accept the preventative treatment. We found that bilinguals using a foreign language perceived disease symptoms and treatment side effects to be less negative than those using their native tongue. Foreign language users were also more likely to account for the objective risks associated with medical conditions and treatments when making decisions about preventative care. We conclude that the use of a native vs. foreign language changes how people evaluate the consequences of accepting and declining preventative treatment, with potential implications for millions of providers and patients who routinely make medical choices in their non-native tongue.