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Binkowski S, Roberts A, Fried L, Nicholas JA, Frearson K, Davis EA, Cherian S, Abraham MB. Perspectives of culturally and linguistically diverse families in the management of children with type 1 diabetes in Western Australia. ETHNICITY & HEALTH 2023:1-14. [PMID: 36935189 DOI: 10.1080/13557858.2023.2190063] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Children with Type 1 diabetes (T1D) from different ethnic backgrounds are growing in proportion in clinical practice and tend to have a higher risk of poor health outcomes. The study aimed to investigate the perspectives of culturally and linguistically diverse families in the management of children with T1D in Western Australia. DESIGN A generic qualitative approach was used. Families of children and adolescents with T1D with first-generation African, Asian or Middle Eastern background were invited to participate in a semi-structured interview. The interviews were audio-recorded, transcribed and analysed thematically. Demographic, clinical and socio-economic data were collected from all participants. RESULTS Fifteen families (27% African, 33% Middle Eastern, 40% Asian) participated in the study. The mean (SD) age of the child with T1D was 10.2 (5.1) years, had diabetes for 2.9 (1.6) years and an average HbA1c of 67 (15) mmol/mol. Four main themes were identified through qualitative analysis. 'Dietary challenges': lack of adequate food resources posed a barrier to determine carbohydrate amount in traditional meals; 'Linguistic challenges': inadequate reading and language skills affected comprehension of written information and the desire for pictorial resources was reported; 'Limited Support': absence of extended family made management of T1D difficult; and 'Knowledge': a key facilitator, which was acquired through clinic education, enabled families to develop skills to effectively manage T1D. CONCLUSION The study highlights the need to consider cultural diversity, psychosocial needs, English proficiency and health literacy when assessing and planning diabetes education. These findings will be useful to formulate a more culturally sensitive approach to diabetes education to improve care and outcomes for young people with T1D from culturally and linguistically diverse families.
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Affiliation(s)
- Sabrina Binkowski
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Alison Roberts
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
| | - Leanne Fried
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Jennifer A Nicholas
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
| | - Kingsley Frearson
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
| | - Sarah Cherian
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
- Refugee Health Service, Department of General Paediatrics, Perth Children's Hospital, Perth, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Mary B Abraham
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia
- Discipline of Paediatrics, The University of Western Australia, Perth, Australia
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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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Gerchow L, Burka LR, Miner S, Squires A. Language barriers between nurses and patients: A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:534-553. [PMID: 32994104 PMCID: PMC8011998 DOI: 10.1016/j.pec.2020.09.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/05/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Global migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers. METHODS A systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists. RESULTS 48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions. CONCLUSION Generally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload. PRACTICE IMPLICATIONS This review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.
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Affiliation(s)
- Lauren Gerchow
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA.
| | - Larissa R Burka
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA
| | - Sarah Miner
- St. John Fisher College Wegmans School of Nursing, 3690 East Ave, Rochester, NY, USA
| | - Allison Squires
- New York University Rory Meyers College of Nursing, 433 1st Ave, New York, NY, USA
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George RE, Smith K, OʼReilly M, Dogra N. Perspectives of Patients With Mental Illness on How to Better Teach and Evaluate Diversity Education in the National Health Service. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2019; 39:92-102. [PMID: 31021967 DOI: 10.1097/ceh.0000000000000250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Diversity education is a mandatory requirement for all mental-health practitioners and health care professionals in the UK National Health Service. Wide variability exists in the development, delivery, and evaluation of diversity education across health care settings, with limited evidence to suggest the optimal approach for teaching this subject. This study aimed to explore the perspectives of patients with mental illness on how to better teach and evaluate diversity education in the National Health Service. METHODS A participatory research approach was used with five mental-health patient organizations. Forty-two patients with mental illness took part in three participatory workshops. Data were analyzed through template analysis. RESULTS The findings indicated that a focus on the nuances and dynamics of clinical relationships would be beneficial. Specifically, the relationship considered most important to examine with respect to diversity education was the "practitioner-self" relationship. DISCUSSION Reconstructing the relationship-centered care model with the addition of the practitioner-self relationship may be better suited to theoretically informing future developments in diversity education. Further research is needed to understand what educational approaches contribute toward a relationship-centered care outlook and how relationship building behaviors, particularly those relevant to the practitioner-self relationship are best developed in diverse settings.
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Affiliation(s)
- Riya Elizabeth George
- Dr. George: Lecturer in Clinical Communication Skills, Queen Mary University of London, and Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, Robin Brook Centre, St Bartholomew's Hospital, London. Mr. Smith: Member of the Patient Advisory Forum, Health Education England, London, United Kingdom. Dr. O'Reilly: Senior Lecturer, University of Leicester and Research Consultant, NHS, Greenwood Institute of Child Health, Leicester, United Kingdom. Dr. Dogra: Professor of Psychiatry Education and Honorary Consultant in Child and Adolescent Psychiatry, University of Leicester, Greenwood Institute of Child Health, Leicester, United Kingdom
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Sturman N, Farley R, Claudio F, Avila P. Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e233-e240. [PMID: 28980405 DOI: 10.1111/hsc.12504] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/09/2017] [Indexed: 06/07/2023]
Abstract
Healthcare consultations with patients lacking English proficiency are challenging for all parties, even in Australian primary care where the engagement of interpreters is encouraged and fully subsidised. Our objective was to understand these challenges from the perspectives of interpreters, patients and general practitioners in order to improve the effectiveness of interpreted consultations. Our investigator team approached the interpreted consultation as an interprofessional collaboration. A convenience sample of seven general practitioners, eight health interpreters and six representatives from culturally and linguistically diverse communities (representing the patient perspective) participated in three separate focus group discussions, lasting 60-90 min each, exploring participant experiences with healthcare consultations in which interpreters were present. Two semistructured interviews were undertaken subsequently with three additional community representatives purposively recruited to increase participant diversity. Data were collected in 2016 and analysed inductively using a method of constant comparison to identify, and reach consensus on, key emerging themes. All participant groups emphasised the importance of working with trained interpreters, rather than relying on family interpreters or a doctor's own second language skills. Although participants reported experiences of effective interpreted consultations, other reports suggested that some doctors are unaware of, or have difficulty following, accepted guidelines about speech, gaze and turn-taking. Challenges identified in relation to interpreted consultations fell into the five themes of contextual constraints, consultation complexity, communication difficulties, the interpreter role and collaboration. Some general practitioner participants appeared to be unsure and anxious about the etiquette of interpreted consultations, and there was some confusion between and within participant groups about interpreter roles and professional codes. A briefing session prior to the consultation, clarifying the roles of all parties, including any family or bicultural workers present, may help to establish respectful, flexible and effective interprofessional collaborations and to encourage participants to directly address any problems during the consultation.
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Affiliation(s)
- Nancy Sturman
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Farley
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Fernanda Claudio
- School of Social Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Patricia Avila
- Regional Advisory Committee, National Accreditation Authority of Translators and Interpreters, Brisbane, Queensland, Australia
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Zamudio CD, Sanchez G, Altschuler A, Grant RW. Influence of Language and Culture in the Primary Care of Spanish-Speaking Latino Adults with Poorly Controlled Diabetes: A Qualitative Study. Ethn Dis 2017; 27:379-386. [PMID: 29225438 DOI: 10.18865/ed.27.4.379] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background We examined the role of language and culture in the interactions between Spanish-speaking Latino patients with poorly controlled diabetes - a fast-growing population in the United States - and their primary care providers. Methods We conducted four focus groups with 36 non-US born Spanish-speaking patients with elevated HbA1c. Participants were insured health plan members with either English-speaking (2 groups) or Spanish-speaking (2 groups) primary care providers. Moderated discussions focused on visit preparation, communication during visit, and role of other care team members. Key themes derived from these discussions were then linked to corresponding Latino cultural constructs. Results Patients had a mean age of 57.9 (±11.2) years and last measured HbA1c was 8.6% (1.5%). Two communication-related themes (reluctance to switch providers and use of intermediaries) and two visit-related themes (provider-driven visit agendas and problem-based visits) emerged from our analyses. These themes reflected the cultural constructs of confianza (trust), familismo (family), respeto (deference), and simpatía (harmonious relationship). Trust in the patient-provider relationship led many participants to remain with English-speaking providers who treated them well. Patients with either language concordant and discordant providers reported reliance on family or other intermediaries to close communication gaps. Deference to physician expertise and authority led to visit expectations that it is the doctor's job to know what to ask and that visits were intended to address specific, often symptom-driven problems. Conclusions Spanish-speaking Latino patients' cultural expectations play an important role in framing their primary care interactions. Recognizing culturally influenced visit expectations is an important step toward improving patient-provider communication.
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Affiliation(s)
- Cindy D Zamudio
- School of Medicine, University of California-Davis, Sacramento, California
| | - Gabriela Sanchez
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Richard W Grant
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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Rivas C, Sohanpal R, MacNeill V, Steed L, Edwards E, Antao L, Griffiths C, Eldridge S, Taylor S, Walton R. Determining counselling communication strategies associated with successful quits in the National Health Service community pharmacy Stop Smoking programme in East London: a focused ethnography using recorded consultations. BMJ Open 2017; 7:e015664. [PMID: 29079601 PMCID: PMC5665230 DOI: 10.1136/bmjopen-2016-015664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To determine communication strategies associated with smoking cessation in the National Health Service community pharmacy Stop Smoking programme. SETTING 11 community pharmacies in three inner east London boroughs. PARTICIPANTS 9 stop smoking advisers and 16 pairs of smokers who either quit or did not quit at 4 weeks, matched on gender, ethnicity, age and smoking intensity. METHOD 1-3 audio-recorded consultations between an adviser and each pair member over 5-6 weeks were analysed using a mixed-method approach. First a content analysis was based on deductive coding drawn from a theme-oriented discourse analysis approach and the Roter Interaction Analysis System. Core themes were identified through this quantification to explore in detail the qualitative differences and similarities between quitters and non-quitters. RESULTS Quantitative analysis revealed advisers used a core set of counselling strategies that privileged the 'voice of medicine' and often omitted explicit motivational interviewing. Smokers tended to quit when these core strategies were augmented by supportive talk, clear permission for smokers to seek additional support from the adviser between consultations, encouragement for smokers to use willpower. The thematic analysis highlighted the choices made by advisers as to which strategies to adopt and the impacts on smokers. The first theme 'Negotiating the smoker-adviser relationship' referred to adviser judgements about the likelihood the smoker would quit. The second theme, 'Roles of the adviser and smoker in the quit attempt', focused on advisers' counselling strategies, while the third theme, 'Smoker and adviser misalignment on reasons for smoking, relapsing and quitting', concerned inconsistencies in the implementation of National Centre for Smoking Cessation and Training recommendations. DISCUSSION Advisers in community pharmacies should use the advantages of their familiarity with smokers to ensure appropriate delivery of patient-centred counselling strategies and reflect on the impact on their counselling of early judgements of smoker success.
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Affiliation(s)
- Carol Rivas
- Social Science Research Unit, University College London, London, UK
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Ratna Sohanpal
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | | | - Liz Steed
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Elizabeth Edwards
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Laurence Antao
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Stephanie Taylor
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Robert Walton
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Wood F, Phillips K, Edwards A, Elwyn G. Working with interpreters: The challenges of introducing Option Grid patient decision aids. PATIENT EDUCATION AND COUNSELING 2017; 100:456-464. [PMID: 27745941 DOI: 10.1016/j.pec.2016.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/15/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE We aimed to observe how an Option Grid™ decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. METHODS Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. RESULTS Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. CONCLUSION Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. PRACTICE IMPLICATIONS Option Grid decision aids are not being used as intended in interpreted consultations.
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Affiliation(s)
- Fiona Wood
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Katie Phillips
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover NH USA
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Alpers LM. Distrust and patients in intercultural healthcare: A qualitative interview study. Nurs Ethics 2016; 25:313-323. [DOI: 10.1177/0969733016652449] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The importance of trust between patients and healthcare personnel is emphasised in nurses’ and physicians’ ethical codes. Trust is crucial for an effective healthcare personnel–patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of ‘othering’. Aim: To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of ‘othering’. Research design: Qualitative design, in-depth interviews and hermeneutic analysis. Participants and research context: The interviewees were 10 immigrant patients (six women and four men – eight Asians, two Africans – ages 32–85 years) recruited from a south-eastern Norwegian hospital. Ethical considerations: Study approval was obtained from the hospital’s Privacy Ombudsman for Research and the hospital’s leadership. Participation was voluntary and participants signed an informed consent form. Conclusion: Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient–healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust.
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Affiliation(s)
- Lise-Merete Alpers
- Lovisenberg Diaconal Hospital, Norway; Oslo and Akershus University College of Applied Sciences, Norway
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Kishimoto M, Noda M. Factors complicating the diabetes management of visitors to Japan: advices from a Japanese National Center for overseas medical staff. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:15-8. [DOI: 10.2152/jmi.63.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Miyako Kishimoto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine
- Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
- Department of Internal Medicine, Sanno Hospital
| | - Mitsuhiko Noda
- Diabetes and Metabolism Information Center, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
- Department of Endocrinology and Diabetes, Saitama Medical University
- Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine
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Kelly M, Rivas C, Foell J, Llewellyn-Dunn J, England D, Cocciadiferro A, Hull S. Unmasking quality: exploring meanings of health by doing art. BMC FAMILY PRACTICE 2015; 16:28. [PMID: 25888088 PMCID: PMC4343066 DOI: 10.1186/s12875-015-0233-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 01/26/2015] [Indexed: 11/10/2022]
Abstract
Background Quality in healthcare has many potential meanings and interpretations. The case has been made for conceptualisations of quality that place more emphasis on describing quality and less on measuring it through structured, vertically oriented metrics. Through discussion of an interdisciplinary community arts project we explore and challenge the dominant reductionist meanings of quality in healthcare. Discussion The model for structured participatory arts workshops such as ours is ‘art as conversation’. In creating textile art works, women involved in the sewing workshops engaged at a personal level, developing confidence through sharing ideas, experiences and humour. Group discussions built on the self-assurance gained from doing craft work together and talking in a relaxed way with a common purpose, exploring the health themes which were the focus of the art. For example, working on a textile about vitamin D created a framework which stimulated the emergence of a common discourse about different cultural practices around ‘going out in the sun’. These conversations have value as ‘bridging work’, between the culture of medicine, with its current emphasis on lifestyle change to prevent illness, and patients’ life worlds. Such bridges allow for innovation and flexibility to reflect local public health needs and community concerns. They also enable us to view care from a horizontally oriented perspective, so that the interface in which social worlds and the biomedical model meet and interpenetrate is made visible. Summary Through this interdisciplinary art project involving academics, health professionals and the local community we have become more sensitised to conceptualising one aspect of health care quality as ensuring a ‘space for the story’ in health care encounters. This space gives precedence to the patient narratives, but acknowledges the importance of enabling clinicians to have time to share stories about care. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0233-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moira Kelly
- Centre for Medical Education, Institute of Health Sciences Education, Queen Mary University of London, Room 2.10, Garrod Building, Turner Street, Whitechapel, London, E1 2AD, UK.
| | - Carol Rivas
- University of Southampton, School of Health Sciences, Highfield, Building 67, Southampton, SO17 1BJ, UK.
| | - Jens Foell
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University London, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, UK.
| | - Janet Llewellyn-Dunn
- Stitches in Time, Old Limehouse Town Hall, 646 Commercial Road, London, E14 7HA, UK.
| | - Diana England
- Stitches in Time, Old Limehouse Town Hall, 646 Commercial Road, London, E14 7HA, UK.
| | - Anna Cocciadiferro
- Stitches in Time, Old Limehouse Town Hall, 646 Commercial Road, London, E14 7HA, UK.
| | - Sally Hull
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University London, Yvonne Carter Building, 58 Turner Street, Whitechapel, London, E1 2AB, UK.
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Hsieh E. Not just "getting by": factors influencing providers' choice of interpreters. J Gen Intern Med 2015; 30:75-82. [PMID: 25338731 PMCID: PMC4284281 DOI: 10.1007/s11606-014-3066-8] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 05/08/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Providers consistently underutilize professional interpreters in healthcare settings even when they perceive benefits to using professional interpreters and when professional interpreters are readily available. Little is known about providers' decision-making processes that shape their use of interpreters. OBJECTIVE To understand the variety of considerations and parameters that influence providers' decisions regarding interpreters. DESIGN A qualitative, semi-structured interview guide was used to explore providers' decision making about interpreter use. The author conducted 8 specialty-specific focus groups and 14 individual interviews, each lasting 60-90 minutes. PARTICIPANTS Thirty-nine healthcare professionals were recruited from five specialties (i.e., nursing, mental health, emergency medicine, oncology, and obstetrics-gynecology) in a large academic medical center characterized as having "excellent" interpreter services. APPROACH Audio-recorded interviews and focus groups were transcribed and analyzed using grounded theory to develop a theoretical framework for providers' decision-making processes. KEY RESULTS Four factors influence providers' choice of interpreters: (a) time constraints, (b) alliances of care, (c) therapeutic objectives, and (d) organizational-level considerations. The findings highlight (a) providers' calculated use of interpreters and interpreting modalities, (b) the complexity of the functions and impacts of time in providers' decision-making process, and (c) the importance of organizational structures and support for appropriate and effective interpreter utilization. CONCLUSIONS Providers actively engage in calculated use of professional interpreters, employing specific factors in their decision-making processes. Providers' understanding of time is complex and multidimensional, including concerns about disruptions to their schedules, overburdening others' workloads, and clinical urgency of patient condition, among others. When providers make specific choices due to time pressure, they are influenced by interpersonal, organizational, therapeutic, and ethical considerations. Organizational resources and guidelines need to be consistent with institutional policies and professional norms; otherwise, providers risk making flawed assessments about the effective and appropriate use of interpreters in bilingual health care.
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Affiliation(s)
- Elaine Hsieh
- Department of Communication, University of Oklahoma, 610 Elm Ave #101, Norman, OK, 73019, USA,
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Abstract
OBJECTIVE To identify characteristics of consultations that do not conform to the traditionally understood communication 'dyad', in order to highlight implications for medical education and develop a reflective 'toolkit' for use by medical practitioners and educators in the analysis of consultations. DESIGN A series of interdisciplinary research workshops spanning 12 months explored the social impact of globalisation and computerisation on the clinical consultation, focusing specifically on contemporary challenges to the clinician-patient dyad. Researchers presented detailed case studies of consultations, taken from their recent research projects. Drawing on concepts from applied sociolinguistics, further analysis of selected case studies prompted the identification of key emergent themes. SETTING University departments in the UK and Switzerland. PARTICIPANTS Six researchers with backgrounds in medicine, applied linguistics, sociolinguistics and medical education. One workshop was also attended by PhD students conducting research on healthcare interactions. RESULTS The contemporary consultation is characterised by a multiplicity of voices. Incorporation of additional voices in the consultation creates new forms of order (and disorder) in the interaction. The roles 'clinician' and 'patient' are blurred as they become increasingly distributed between different participants. These new consultation arrangements make new demands on clinicians, which lie beyond the scope of most educational programmes for clinical communication. CONCLUSIONS The consultation is changing. Traditional consultation models that assume a 'dyadic' consultation do not adequately incorporate the realities of many contemporary consultations. A paradox emerges between the need to manage consultations in a 'super-diverse' multilingual society, while also attending to increasing requirements for standardised protocol-driven approaches to care prompted by computer use. The tension between standardisation and flexibility requires addressing in educational contexts. Drawing on concepts from applied sociolinguistics and the findings of these research observations, the authors offer a reflective 'toolkit' of questions to ask of the consultation in the context of enquiry-based learning.
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Affiliation(s)
- Deborah Swinglehurst
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London, London, UK
| | - Celia Roberts
- Department of Education and Professional Studies, King's College London, London, UK
| | - Shuangyu Li
- Division of Medical Education, School of Medicine, King's College London, London, UK
| | - Orest Weber
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Singy
- Psychiatric Liaison Service, Lausanne University Hospital, Lausanne, Switzerland
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Hudelson P, Dao MD, Perron NJ, Bischoff A. Interpreter-mediated diabetes consultations: a qualitative analysis of physician communication practices. BMC FAMILY PRACTICE 2013; 14:163. [PMID: 24152539 PMCID: PMC4016471 DOI: 10.1186/1471-2296-14-163] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 10/21/2013] [Indexed: 11/16/2022]
Abstract
Background Patient-provider communication, in particular physicians’ ability to listen to their patients, and support them in making difficult lifestyle changes, is an essential component of effective diabetes care. Clinical communication around diabetes can be especially challenging when language barriers are present, and may contribute to poor diabetes management and outcomes. Clinicians need to be aware of and address potential communication difficulties associated with interpreter-mediated consultations. The purpose of our study was to explore how physicians communicate in interpreter-mediated consultations with diabetic patients, and how their communication behaviors may impact diabetes communication and care. Method We analyzed transcripts from 8 audio recorded, outpatient consultations at the Basel University Hospital general medicine outpatient clinic involving Turkish-speaking patients, German-speaking physicians, and Turkish-German interpreters (both community interpreters and family members). Results Clinicians used closed questions when asking about symptoms and glucose control. When providing information and explanation, they spoke in long and complex speech turns. They often directed their speech to interpreters or became sidetracked by family members’ questions or requests for information. Patients’ participation in the consultation was minimal, and limited to brief answers to clinicians’ questions. Conclusions Clinicians need to be aware of common pitfalls that diminish patient-centeredness during interpreter-mediated consultations, and learn strategies to avoid them. Attention to established guidelines on triadic communication is recommended, as is hands-on training with interpreters.
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Affiliation(s)
- Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland.
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Seale C, Rivas C, Al-Sarraj H, Webb S, Kelly M. Moral mediation in interpreted health care consultations. Soc Sci Med 2013; 98:141-8. [PMID: 24331892 DOI: 10.1016/j.socscimed.2013.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/12/2013] [Accepted: 09/17/2013] [Indexed: 11/17/2022]
Abstract
This paper reports on the moral work done in routine diabetes review consultations in primary care with nurses. Consultations with fluent English speakers are compared with consultations where an interpreter was present, largely involving patients of Bangladeshi origin. The study setting was Tower Hamlets in London, where type 2 diabetes is particularly common. Existing research has shown some dissatisfaction with diabetes care amongst Bangladeshi patients, and studies of care providers in other locations suggest that they at times experience the care of this group as particularly challenging. Through analysis of video-recorded consultations recorded in 2010-2011 we shed light on possible reasons for these difficulties. The 12 non-English speakers often experienced difficulties in raising issues that concerned them, particularly if their interpreter did not translate their utterance because it was deemed to be unrelated to diabetes. These difficulties were not shared by the 24 fluent English speakers, who also found it easier to convey a positive moral reputation and to excuse behaviour that deviated from recommended self-management practices. Interpreters at times also acted as moral mediators. For example, where a participant in the consultation made statements that appeared to convey a negative moral judgement of an other participant, these would often go untranslated. Probably, neither health care providers nor patients are fully aware of the nature of their communication difficulties. Given this, interpreters possess considerable power to influence matters. Understanding the moral work of consultations is important in explaining the findings of other studies showing difficulties in the provision of diabetes care to people with limited English language skills.
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Affiliation(s)
- Clive Seale
- Department of Sociology and Communications, Brunel University, Uxbridge, Middlesex UB8 3PH, UK.
| | - Carol Rivas
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.
| | - Hela Al-Sarraj
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.
| | - Sarah Webb
- Centre for Primary Care and Public Health, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.
| | - Moira Kelly
- Centre for Medical Education, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK.
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The challenge of communication in interpreted consultations in diabetes care. Br J Gen Pract 2013; 63:290-1. [PMID: 23735381 DOI: 10.3399/bjgp13x668069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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