Understanding Professional Medical Interpreters' Perspectives on Advancing Accurate and Culturally Informed Patient-Provider Communication for Filipinos in Hawai'i: Qualitative Analysis

One in every eight persons in Hawai'i, USA, have limited English proficiency (LEP) and are entitled to free language assistance for federally funded services under Title IV of the Civil Rights Act of 1964. They also have the right to culturally and linguistically appropriate services (CLAS) provided by professional medical interpreters (PMIs). This study's goals were to uncover barriers and facilitators of CLAS from the perspective of PMIs. PMIs for Filipino languages (n = 10) participated in an online survey and semi-structured interviews. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using conventional content analysis. Six themes emerged in the qualitative analysis: (1) cultural and social factors that can influence patient-provider communication; (2) barriers to effective patient-provider communication: patient, healthcare provider, and PMI levels; (3) facilitators of effective patient-provider communication: patient, healthcare provider, and PMI levels; (4) COVID-19 and remote interpreting barriers and facilitators; (5) strengths and weaknesses of in-person and stand-by interpreting appointments; and, (6) recommendations: system and provider levels. Proposed interventions could include advertising language services among Filipino communities and educating them about their language rights, providing additional resources for language assistance, employing more PMIs, training staff/providers, and supporting the use of PMIs versus untrained individuals.

Adaptation of the Health Literacy Survey Questionnaire (HLS19-Q) for Russian-Speaking Populations-International Collaboration across Germany, Israel, Kazakhstan, Russia, and the USA

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS₁₉-Q) developed within the Health Literacy Survey 2019–2021 (HLS₁₉) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS₁₉-Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS₁₉ protocol and “team approach” method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS₁₉-Q questions to each country’s healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS₁₉-Q into different languages and can serve as an example of international collaboration towards this end.

Cervical Cancer Screening Experiences Among Chinese American Immigrant Women in the United States

OBJECTIVE

To understand the experiences and perceptions of having cervical cancer screening tests and to explore the extant barriers to having the tests among first-generation Chinese American women in the United States.

DESIGN

Qualitative, descriptive, phenomenological research.

SETTING

Los Angeles, California.

PARTICIPANTS

Snowball and purposive sampling of 12 Chinese American immigrant women ages 20 to 65 years.

METHODS

Individual face-to-face, in-depth, semistructured interviews in which participants were asked about their experiences and perceptions about cervical cancer screening. Interviews were audiotaped, transcribed, and translated into English. Data analysis included comparing and distinguishing, collecting and counting, and presupposing and inferring.

RESULTS

Through the analysis process, we identified four major themes that reflected the experiences, perceptions, and barriers to having cervical cancer screening among Chinese American women: Belief in a Healthy Lifestyle, Maintaining Privacy for Female Health Problems, Fear of Losing Control, and Feeling Vulnerable in an Unfamiliar Health Care System. These themes indicated that Chinese immigrant women in the United States face challenges to their cultural health beliefs and practices with regard to decision-making and health-seeking behaviors related to cervical cancer screening. They felt more vulnerable as immigrants because of systematic barriers to navigation of the unfamiliar health care system and limited resources.

CONCLUSION

Women's health care providers should be aware of and give consideration to cultural differences through the provision of more educational information and comfort to Chinese immigrant women who seek cervical cancer screening. Ultimately, the development of culturally appropriate and affordable cancer prevention programs with effective strategies is important to ease Chinese American women's senses of vulnerability.

``How am I going to work?'' Barriers to employment for immigrant Latinos and Latinas living with HIV in Toronto

BACKGROUND

For individuals with HIV positive status, multiple barriers exist to accessing and re-entering employment. Studies on employment for people living with HIV lack a detailed consideration of race and ethnicity. This is the first article that focuses on barriers to employment for the HIV positive Latino community in the Canadian context.

OBJECTIVE

To document the barriers that a sample of HIV positive Latinos and Latinas encounter in finding and maintaining employment in Toronto.

METHODS

A non-probability sample of immigrant and refugee Latino men and women living with HIV/AIDS in Toronto participated in in-depth interviews concerning their experiences in the labor market, emphasizing the barriers that they have faced in access to employment. Interviews were audio recorded, transcribed and later analysed with NVivo 9.

RESULTS

Two sets of barriers emerged from the analysis: structural barriers that immigrants encounter in access to employment, such as language difficulties, lack of Canadian work experience and anti-immigrant feelings and barriers to employment for HIV positive individuals, principally HIV related stigma and health related issues.

CONCLUSIONS

Due to their intersectional identities as immigrants/refugees and HIV positive individuals, participants face compounded barriers to employment: Language difficulties, lack of migrant status and Canadian work experience, anti-immigrant sentiments in the labor market, ageism, HIV related stigma and side effects of medications among other barriers related with an HIV positive condition. Such barriers locate participants in a marginalized position in Canadian society.

Health Care Experiences and Perceived Barriers to Health Care Access: A Qualitative Study Among African Migrants in Guangzhou, Guangdong Province, China

Guangzhou, one of China's largest cities and a main trading port in South China, has attracted many African businessmen and traders migrating to the city for financial gains. Previous research has explored the cultural and economic roles of this newly emerging population; however, little is known about their health care experiences while in China. Semi-structured interviews and focus groups were used to assess health care experiences and perceived barriers to health care access among African migrants in Guangzhou, China. Overall, African migrants experienced various barriers to accessing health care and were dissatisfied with local health services. The principal barriers to care reported included affordability, legal issues, language barriers, and cultural differences. Facing multiple barriers, African migrants have limited access to care in Guangzhou. Local health settings are not accustomed to the African migrant population, suggesting that providing linguistically and culturally appropriate services may improve access to care for the migrants.

Guidelines for conducting rigorous health care psychosocial cross-cultural/language qualitative research

The purpose of this article is to synthesize and chronicle the authors' experiences as four bilingual and bicultural researchers, each experienced in conducting cross-cultural/cross-language qualitative research. Through narrative descriptions of experiences with Latinos, Iranians, and Hmong refugees, the authors discuss their rewards, challenges, and methods of enhancing rigor, trustworthiness, and transparency when conducting cross-cultural/cross-language research. The authors discuss and explore how to effectively manage cross-cultural qualitative data, how to effectively use interpreters and translators, how to identify best methods of transcribing data, and the role of creating strong community relationships. The authors provide guidelines for health care professionals to consider when engaging in cross-cultural qualitative research.

Korean immigrant women's lived experience of childbirth in the United States

OBJECTIVE

To understand Korean immigrant women's common experiences and practices of utilizing health care services in the United States during childbirth.

DESIGN

A qualitative interpretive phenomenological research design.

SETTING

Recruitment was conducted through advertisement on the MissyUSA.com website, which is the largest online community for married Korean women who live in North America.

PARTICIPANTS

A purposive sample of 15 Korean immigrant women who experienced childbirth in the United States within the past 5 years was recruited.

METHODS

Data were collected using semistructured telephone interviews and were analyzed using the Heideggerian hermeneutical methodology.

RESULTS

During childbirth in the United States, participants faced multifaceted barriers in unfamiliar sociocultural contexts yet maintained their own cultural heritages. They navigated the unfamiliar health care system and developed their own strategies to overcome barriers to health care access. Korean immigrant women actively sought health information on the Internet and through social networking during childbirth.

CONCLUSIONS

Korean immigrant women selectively accepted new cultural beliefs with some modifications from their own cultural contexts and developed their own distinct birth cultures. Understanding a particular culture and respecting women's traditions, beliefs, and practices about their childbirth could help nurses to provide culturally sensitive care.

"It is a challenge to do it the right way": an interpretive description of caregivers' experiences in caring for migrant patients in Northern Sweden

BACKGROUND

Experiences from nations with population diversity show extensive evidence on the need for cultural and linguistic competence in health care. In Sweden, despite the increasing diversity, only few studies have focused on challenges in cross-cultural care. The aim of this study was to explore the perspectives and experiences of caregivers in caring for migrant patients in Northern Sweden in order to understand the challenges they face and generate knowledge that could inform clinical practice.

METHODS

We used an interpretive description approach, combining semi-structured interviews with 10 caregivers purposively selected and participant observation of patient-provider interactions in caring encounters. The interviews were transcribed and analyzed using thematic analysis approach. Field notes were also used to orient data collection and confirm or challenge the analysis.

RESULTS

We found complex and intertwined challenges as indicated in the three themes we present including: the sociocultural diversity, the language barrier and the challenges migrants face in navigating through the Swedish health care system. The caregivers described migrants as a heterogeneous group coming from different geographical areas with varied social, cultural and religious affiliations, migration histories and statuses, all of which influenced the health care encounter, whether providing or receiving. Participants also described language as a major barrier to effective provision and use of health services. Meanwhile, they expressed concern over the use of interpreters in the triad communication and over the difficulties encountered by migrants in navigating through the Swedish health care system.

CONCLUSIONS

The study illuminates complex challenges facing health care providers caring for migrant populations and highlights the need for multifaceted approaches to improve the delivery and receipt of care. The policy implications of these challenges are discussed in relation to the need to (a) adapt care to the individual needs, (b) translate key documents and messages in formats and languages accessible and acceptable to migrants, (c) train interpreters and enhance caregivers' contextual understanding of migrant groups and their needs, (d) and improve migrants' health literacy through strategies such as community based educational outreach.

Deportation experiences of women who inject drugs in Tijuana, Mexico

Deportation from the United States for drug offenses is common, yet the consequences of deportation for women drug users are poorly documented. In 2008, in Tijuana, Mexico, we conducted an exploratory qualitative study of migration, deportation, and drug abuse by interviewing 12 Mexican injection-drug-using women reporting U.S. deportation. Women reported heavy drug use before and after deportation, but greater financial instability and physical danger following deportation than when in the United States. We identified an unmet need for health and social services among deported drug-using women, including HIV prevention, drug treatment, physical and mental health services, and vocational training. Binational coordination is needed to help deported women resettle in Mexico.

Passing through: meanings of survivorship and support among Filipinas with breast cancer

Breast cancer among Filipinas in the United States is a major but largely neglected cancer disparity. In 2004, a community- university partnership resulted in the first Filipina breast cancer support group in the San Francisco Bay Area. Building on this partnership, we explored the social and cultural contexts of Filipinas' experiences with breast cancer to inform development of culturally appropriate and sustainable support services and outreach. We utilized multiple qualitative methods (participant observation, individual and small group in-depth qualitative interviews) to identify meanings of survivorship and support. Interviews and observations revealed the influences of social context and immigration experiences on women's understandings of cancer, what "surviving" cancer means, and what it means to take care of someone with breast cancer (or be taken care of). Our findings highlight the importance of a transnational perspective for the study of immigrant women's experiences of cancer and survivorship.