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Chan DNS, Lee PPK, So WKW. Exploring the Barriers and Facilitators Influencing Human Papillomavirus Vaccination Decisions Among South Asian and Chinese Mothers: a Qualitative Study. J Racial Ethn Health Disparities 2024; 11:1465-1477. [PMID: 37195592 PMCID: PMC10191075 DOI: 10.1007/s40615-023-01623-4] [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: 11/09/2022] [Revised: 02/23/2023] [Accepted: 04/26/2023] [Indexed: 05/18/2023]
Abstract
Human papillomavirus (HPV) vaccines are safe and effective in preventing HPV infection and HPV-related cancers. However, the HPV vaccine uptake rate is lower among the ethnic minority population than in the majority population. This qualitative study explored the barriers and facilitators influencing South Asian minority and Chinese mothers' decisions to vaccinate their daughters against HPV in Hong Kong. South Asian and Chinese mothers with at least one daughter aged 9 to 17 years were recruited to this study. Twenty-two semi-structured focus group interviews were conducted, and the transcripts were analysed via content analysis. Two barriers and three facilitating factors were common among South Asian and Chinese mothers: inadequate knowledge of cervical cancer, HPV or the HPV vaccine and high perceived barriers to HPV vaccination due to vaccine cost, the receipt of reliable information from schools or the government, high perceived benefits of HPV vaccination to health, and the presence of vaccination programme arranged by school or government. Despite these commonalities, South Asian mothers experienced more barriers to making the decision to vaccinate than Chinese mothers. Particularly, obtaining family support was an important factor for South Asian mothers. The vaccination decision was considered a joint decision between the mother and father, and the father's agreement was of particular importance to Pakistani mothers. This study identified the factors that hindered and facilitated South Asian and Chinese mothers' decisions to vaccinate their daughters against HPV. The comparison between groups improves our understanding of the distinct needs of South Asian in Hong Kong.
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Affiliation(s)
- Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Pinky Pui Kay Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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2
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Hamai T, Nagata A, Ono N, Nishikawa H, Higashino S. Evaluating a conceptual framework for quality assessment of medical interpretation. PATIENT EDUCATION AND COUNSELING 2024; 123:108233. [PMID: 38447476 DOI: 10.1016/j.pec.2024.108233] [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: 09/07/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE We aimed to evaluate a proposed conceptual framework for quality assessment of medical interpretation using actual data from clinical settings. METHODS A mixed methods approach was used. Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese physicians, and hospital-provided and ad hoc interpreters were digitally recorded and transcribed. A questionnaire survey examining participants' satisfaction was conducted; 111 and 13 encounters by hospital-provided and ad hoc interpreters, respectively, were recorded. Segments of consecutively interpreted utterances were coded as "altered," whereby the interpreter changed the meaning of the source utterance, or "unaltered (accurate)." Frequency and type of alteration were analyzed. The effect of positive interpretation alterations on physician-patient interactions was qualitatively described. RESULTS Interpretation accuracy was significantly higher for hospital-provided interpreters, but was not associated with overall patient satisfaction. Overall physician satisfaction was associated with accurate interpretation, clinically negative altered interpretations, and positive voluntary interventions (p < 0.05). Positive alterations promoted patient, physician, and interpreter interactions, which helped to achieve clinical outcomes. CONCLUSION A new conceptual framework for quality assessment of medical interpretation was developed for clinical settings. Healthcare provider satisfaction can provide a measure of interpretation alterations. PRACTICE IMPLICATIONS Healthcare providers can effectively use the conceptual framework to improve medical interpretation and collaboration with healthcare interpreters.
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Affiliation(s)
- Taeko Hamai
- School of Nursing, University of Shizuoka, Shizuoka, Japan.
| | - Ayako Nagata
- College of Nursing and Nutrition, Shukutoku University, Chiba, Japan
| | - Naoko Ono
- Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan
| | | | - Sadanori Higashino
- School of Management and Information, University of Shizuoka, Shizuoka, Japan
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Hudelson P, Chappuis F. Using Voice-to-Voice Machine Translation to Overcome Language Barriers in Clinical Communication: An Exploratory Study. J Gen Intern Med 2024; 39:1095-1102. [PMID: 38347346 PMCID: PMC11116302 DOI: 10.1007/s11606-024-08641-w] [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: 10/16/2023] [Accepted: 01/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Machine translation (MT) apps are used informally by healthcare professionals in many settings, especially where interpreters are not readily available. As MT becomes more accurate and accessible, it may be tempting to use MT more widely. Institutions and healthcare professionals need guidance on when and how these applications might be used safely and how to manage potential risks to communication. OBJECTIVES Explore factors that may hinder or facilitate communication when using voice-to-voice MT. DESIGN Health professionals volunteered to use a voice-to-voice MT app in routine encounters with their patients. Both health professionals and patients provided brief feedback on the experience, and a subset of consultations were observed. PARTICIPANTS Doctors, nurses, and allied health professionals working in the Primary Care Division of the Geneva University Hospitals, Switzerland. MAIN MEASURES Achievement of consultation goals; understanding and satisfaction; willingness to use MT again; difficulties encountered; factors affecting communication when using MT. KEY RESULTS Fourteen health professionals conducted 60 consultations in 18 languages, using one of two voice-to-voice MT apps. Fifteen consultations were observed. Professionals achieved their consultation goals in 82.7% of consultations but were satisfied with MT communication in only 53.8%. Reasons for dissatisfaction included lack of practice with the app and difficulty understanding patients. Eighty-six percent of patients thought MT-facilitated communication was easy, and most participants were willing to use MT in the future (73% professionals, 84% patients). Experiences were more positive with European languages. Several conditions and speech practices were identified that appear to affect communication when using MT. CONCLUSION While professional interpreters remain the gold standard for overcoming language barriers, voice-to-voice MT may be acceptable in some clinical situations. Healthcare institutions and professionals must be attentive to potential sources of MT errors and ensure the conditions necessary for safe and effective communication. More research in natural settings is needed to inform guidelines and training on using MT in clinical communication.
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Affiliation(s)
- Patricia Hudelson
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland.
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - François Chappuis
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Quigley DD, Qureshi N, Predmore Z, Diaz Y, Hays RD. Is Primary Care Patient Experience Associated with Provider-Patient Language Concordance and Use of Interpreters for Spanish-preferring Patients: A Systematic Literature Review. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01951-z. [PMID: 38441859 DOI: 10.1007/s40615-024-01951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Healthcare provided by a bilingual provider or with the assistance of an interpreter improves care quality; however, their associations with patient experience are unknown. We reviewed associations of patient experience with provider-patient language concordance (LC) and use of interpreters for Spanish-preferring patients. METHOD We reviewed articles from academic databases 2005-2023 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Joanna Briggs Institute Checklists to rate study quality. We reviewed 217 (of 2193) articles, yielding 17 for inclusion. RESULTS Of the 17 included articles, most articles focused on primary (n = 6 studies) or pediatric care (n = 5). All were cross-sectional, collecting data by self-administered surveys (n = 7) or interviews (n = 4). Most assessed the relationship between LC or interpreter use and patient experience by cross-sectional associations (n = 13). Two compared subgroups, and two provided descriptive insights into the conversational content (provider-interpreter-patient). None evaluated interventions, so evidence on effective strategies is lacking. LC for Spanish-preferring patients was a mix of null findings (n = 4) and associations with better patient experience (n = 3) (e.g., receiving diet/exercise counseling and better provider communication). Evidence on interpreter use indicated better (n = 2), worse (n = 2), and no association (n = 2) with patient experience. Associations between Spanish-language preference and patient experience were not significant (n = 5) or indicated worse experience (n = 4) (e.g., long waits, problems getting appointments, and not understanding nurses). CONCLUSION LC is associated with better patient experience. Using interpreters is associated with better patient experience but only with high-quality interpreters. Strategies are needed to eliminate disparities and enhance communication for all Spanish-preferring primary care patients, whether with a bilingual provider or an interpreter.
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Affiliation(s)
- Denise D Quigley
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Nabeel Qureshi
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Yareliz Diaz
- RAND Corporation, 20 Park Plaza, Suite 910, Boston, MA, USA
| | - Ron D Hays
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
- David Geffen School of Medicine & Department of Medicine, UCLA, 1100 Glendon Avenue, Los Angeles, CA, 90024-1736, USA
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Twersky SE, Jefferson R, Garcia-Ortiz L, Williams E, Pina C. The Impact of Limited English Proficiency on Healthcare Access and Outcomes in the U.S.: A Scoping Review. Healthcare (Basel) 2024; 12:364. [PMID: 38338249 PMCID: PMC10855368 DOI: 10.3390/healthcare12030364] [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: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.
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Affiliation(s)
- Sylvia E. Twersky
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Rebeca Jefferson
- R. Barbara Gitenstein Library, The College of New Jersey, Ewing Township, NJ 08618, USA;
| | - Lisbet Garcia-Ortiz
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Erin Williams
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
| | - Carol Pina
- Department of Public Health, The College of New Jersey, Ewing Township, NJ 08618, USA; (L.G.-O.)
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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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Ahmed A, Smith M, Mandal S, Bushnik T. Who enrolls and why? Examining center-specific underlying patterns behind enrollment: a New York City-based traumatic brain injury model systems study. Brain Inj 2024; 38:19-25. [PMID: 38219046 DOI: 10.1080/02699052.2024.2304863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
BACKGROUND To elucidate the sociodemographic and study factors involved in enrollment in the Traumatic Brain Injury Model System (TBIMS) database, this study examined the effect of a variety of variables on enrollment at a local TBIMS center. METHODS A sample of 654 individuals from the local TBIMS center was studied examining enrollment by age, gender, race, ethnicity, homelessness status at date of injury, history of homelessness, health insurance status, presence of social support, primary language, consenting in hospital or after discharge, and the need for an interpreter. Binary logistic regression was conducted to identify variables that predict center-based enrollment into TBIMS. RESULTS Results demonstrated that older age was associated with decreasing enrollment (OR = 0.99, p = 0.01), needing an interpreter made enrollment less likely (OR = 0.33, p < 0.01), being primarily Spanish speaking predicted enrollment (OR = 3.20, p = 0.02), Hispanic ethnicity predicted enrollment (OR = 7.31, p = 0.03), and approaching individuals in the hospital predicted enrollment (OR = 6.94, p < 0.01). Here, OR denotes the odds ratio estimate from a logistic regression model and P denotes the corresponding p-value. CONCLUSIONS These results can be useful in driving enrollment strategies at this center for other similar TBI research, and to contribute a representative TBI sample to the national database.
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Affiliation(s)
- Asim Ahmed
- Rusk Rehabilitation at NYU Langone Health, Department of Rehabilitation, New York, NY, United States
- New York Medical College, School of Medicine, Valhalla, NY, United States
| | - Michelle Smith
- Rusk Rehabilitation at NYU Langone Health, Department of Rehabilitation, New York, NY, United States
| | - Soutrik Mandal
- NYU Grossman School of Medicine Department of Population Health, New York, NY, United States
| | - Tamara Bushnik
- Rusk Rehabilitation at NYU Langone Health, Department of Rehabilitation, New York, NY, United States
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Lopez Vera A, Thomas K, Trinh C, Nausheen F. A Case Study of the Impact of Language Concordance on Patient Care, Satisfaction, and Comfort with Sharing Sensitive Information During Medical Care. J Immigr Minor Health 2023; 25:1261-1269. [PMID: 36840903 PMCID: PMC9959935 DOI: 10.1007/s10903-023-01463-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
Linguistic barriers continue to be a source of difficulty and inappropriate treatment in our healthcare system. Several studies have shown the importance of language concordance, which leads to increased trust and higher patient satisfaction. The aim of this is study is to determine patients' satisfaction and comfort levels with sharing sensitive information in Spanish with either the health care provider or an interpreter, respectively, and to compare the results to find out if there is an option that patients prefer. There were two different groups of participants in the study. The experimental group was directly seen by Spanish-speaking student doctors while the control group was seen by English-speaking student doctors that had the aid of an interpreter. Several questions were asked to participants via survey in order to measure their comfort levels during the encounter. The results of this study demonstrate that having Spanish-speaking healthcare providers providing health care to Hispanic patients can raise patients' comfort levels and satisfaction in contrast to having the aid of an interpreter. Providing second language training to student doctors can potentially improve patient care and reduce health inequities facing LEP patients. Given the small sample size of our study, future projects should expand the study to include more participants.
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Affiliation(s)
- Alexandra Lopez Vera
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA.
| | - Kyle Thomas
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Christina Trinh
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
| | - Fauzia Nausheen
- Department of Medical Education, California University of Science and Medicine, Colton, CA, USA
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Tomkow L, Prager G, Drinkwater J, Morris RL, Farrington R. 'That's how we got around it': a qualitative exploration of healthcare professionals' experiences of care provision for asylum applicants' with limited English proficiency in UK contingency accommodation. BMJ Open 2023; 13:e074824. [PMID: 37996230 PMCID: PMC10668227 DOI: 10.1136/bmjopen-2023-074824] [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: 04/18/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES The inadequate provision of language interpretation for people with limited English proficiency (LEP) is a determinant of poor health, yet interpreters are underused. This research explores the experiences of National Health Service (NHS) staff providing primary care for people seeking asylum, housed in contingency accommodation during COVID-19. This group often have LEP and face multiple additional barriers to healthcare access. Language discrimination is used as a theoretical framework. The potential utility of this concept is explored as a way of understanding and addressing inequities in care. DESIGN Qualitative research using semistructured interviews and inductive thematic analysis. SETTING An NHS primary care service for people seeking asylum based in contingency accommodation during COVID-19 housing superdiverse residents speaking a wide spectrum of languages. PARTICIPANTS Ten staff including doctors, nurses, mental health practitioners, healthcare assistants and students participated in semistructured online interviews. Some staff were redeployed to this work due to the pandemic. RESULTS All interviewees described patients' LEP as significant. Inadequate provision of interpretation services impacted the staff's ability to provide care and compromised patient safety. Discrimination, such as that based on migration status, was recognised and challenged by staff. However, inequity based on language was not articulated as discrimination. Instead, insufficient and substandard interpretation was accepted as the status quo and workarounds used, such as gesticulating or translation phone apps. The theoretical lens of language discrimination shows how this propagates existing social hierarchies and further disadvantages those with LEP. CONCLUSIONS This research provides empirical evidence of how the inadequate provision of interpreters forces the hand of healthcare staff to use shortcuts. Although this innovative 'tinkering' allows staff to get the job done, it risks normalising structural gaps in care provision for people with LEP. Policy-makers must rethink their approach to interpretation provision which prioritises costs over quality. We assert that the concept of language discrimination is a valuable framework for clinicians to better identify and articulate unfair treatment on the grounds of LEP.
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Affiliation(s)
| | | | - Jessica Drinkwater
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Rebecca L Morris
- Centre for Primary Care, The University of Manchester, Manchester, UK
| | - Rebecca Farrington
- Division of Medical Education, University of Manchester Faculty of Biology, Medicine and Health, Manchester, UK
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Rosen CB, Roberts SE, Sharpe J, Gershuni V, Altieri MS, Kelz RR. A study analyzing outcomes after bariatric surgery by primary language. Surg Endosc 2023:10.1007/s00464-023-10127-5. [PMID: 37266743 DOI: 10.1007/s00464-023-10127-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Communication is key to success in bariatric surgery. This study aims to understand how outcomes after bariatric surgery differ between patients with a non-English primary language and those with English as their primary language. METHODS This retrospective, observational cohort study of bariatric surgery patients age ≥ 18 years utilized the Michigan, Maryland, and New Jersey State Inpatient Databases and State Ambulatory Surgery and Services Databases, 2016 to 2018. Patients were classified by primary spoken language: English and non-English. Primary outcome was complications. Secondary outcomes included length of stay (LOS) and cost, with cost calculated using cost-to-charge ratios provided by Healthcare Cost and Utilization Project and reported in 2019 United States dollars. Multivariable regression models (logistic, Poisson, and quantile) were used to examine associations between primary language and outcomes. Given the uneven distribution of race by primary language, interaction terms were used to examine conditional effects of race. RESULTS Among 69,749 bariatric surgery patients, 2811 (4.2%) spoke a non-English primary language. Covariates, notably race distribution, and unadjusted outcomes differed significantly by primary language. However, after adjustment, non-English primary language was not associated with significantly increased odds of complications (odds ratio 1.24, p = 0.389), significantly different LOS (- 0.02 days, p = 0.677), nor significantly different mean healthcare costs (- $265, p = 0.309). There were no significant conditional effects of race seen among outcomes. CONCLUSIONS Though non-English primary language was associated with a significantly different distribution of observable characteristics (including race, income quartile, and insurance type), after adjustment, non-English primary language was not associated with significant differential risk of adverse outcomes after bariatric surgery, and there were no significant conditional effects of race. As such, this study suggests that disparities in bariatric surgery by primary spoken language more likely related to access to care, or the pre- and post-hospital care continuum, rather than index hospitalization after surgery.
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Affiliation(s)
- Claire B Rosen
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA.
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA.
| | - Sanford E Roberts
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - James Sharpe
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
| | - Victoria Gershuni
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Maria S Altieri
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
| | - Rachel R Kelz
- Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street 4 Maloney, Philadelphia, PA, 19104, USA
- Center for Surgery and Health Economics, Perelman School of Medicine, Philadelphia, USA
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Perumalswami PV, Belemkoabga A, Joseph L, Erblich J, Jandorf L. HBV screening among West Africans living in the US: Influences of stigma, health literacy, and self-efficacy. Hepatol Commun 2023; 7:02009842-202306010-00030. [PMID: 37267200 DOI: 10.1097/hc9.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/13/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Applying theoretically informed constructs using an adaptation of the "Theory of Planned Behavior," this study assessed social-cognitive and sociocultural determinants of HBV screening among West Africans living in the US to inform solutions to testing gaps. METHODS We developed and administered a theory-based survey in both English (41%) and French (59%) from September 2021 to April 2022 to a sample of West African-born individuals (n = 162). Predictors of HBV screening included: attitudes, perceived behavioral control or self-efficacy, and subjective norms along with health literacy (HL), language proficiency, and stigma of HBV infection. We hypothesized that these constructs would predict HBV testing. We also conducted path analytic modeling to better understand both direct and indirect effects of key factors on HBV screening status. RESULTS West Africans who completed the survey in English were younger with less education and lower income, whereas those who completed the survey in French reported higher HBV-related stigma. In a bivariate analysis of factors associated with HBV screening by language, less education was associated with lower HBV screening in English speakers. Adequate HL, higher self-efficacy, and higher English language proficiency were independently associated with HBV screening. Path analysis to better understand the interplay between social-cognitive and sociocultural factors revealed HL and stigma both had indirect effects on screening, mediated by differences in self-efficacy. CONCLUSIONS This study identified HL and stigma as key indirect factors that influence HBV screening by way of self-efficacy in West Africans in the US. This work is a first step to identifying barriers that can lead to the development of an evidence-based intervention aimed at increasing HBV screening of West Africans to address health disparities.
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Affiliation(s)
- Ponni V Perumalswami
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Assita Belemkoabga
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lovely Joseph
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joel Erblich
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Psychology, Hunter College and The Graduate Center, City University of New York, New York, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Russell EA, Hsu D, Camp EA, Soto-Ruiz K, Leaming-Van Zandt K. Spanish-Speaking Caregivers' Perception of Emergency Physicians' Interpersonal and Communication Skills in a Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:253-258. [PMID: 36999987 DOI: 10.1097/pec.0000000000002681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Medical communication is more than just the delivery of information; language differences between physicians and patients/caregivers create a challenge to providing effective care in the pediatric emergency department (ED). Overcoming this barrier is vital to providing high-quality care. We evaluated Spanish- versus English-speaking caregivers' perception of their pediatric ED physicians' interpersonal and communication skills. We also compared perceptions of Spanish- versus English-speaking caregivers who self-identified as Hispanic. METHODS This study is a retrospective analysis of data from surveys administered in an urban, free-standing children's hospital ED. Surveys were administered in English and Spanish to pediatric patient caregivers. In person, video, and telephonic interpretations were available during patient encounters. RESULTS There were 2542 (82.4%) surveys completed in English and 543 (17.6%) in Spanish. There were significant differences in demographic data of English versus Spanish survey respondents, including level of education, insurance status, and rates of nonpublic insurance. Spanish survey respondents rated their physicians' interpersonal skills lower than English survey respondents. There were 1455 (47%) surveys completed by the respondents who self-identified as Hispanic. Within this group, 928 (63.8%) respondents completed the survey in English and 527 (36.2%) in Spanish. Among this Hispanic population, the Spanish survey respondents rated their physicians' interpersonal and communication skills lower than English survey respondents. After adjusting for education level and insurance type, these differences persisted. CONCLUSIONS Language barriers have a meaningful impact on physician ability to communicate effectively in the pediatric ED. Improving physicians' ability to overcome this barrier is essential toward enriching patient outcomes and experience in the ED.
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Affiliation(s)
- Eric A Russell
- From the Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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13
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Duronjic A, Ku D, Chavan S, Bucci T, Taylor S, Pilcher D. The impact of language barriers & interpreters on critical care patient outcomes. J Crit Care 2023; 73:154182. [PMID: 36368174 DOI: 10.1016/j.jcrc.2022.154182] [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: 07/05/2022] [Revised: 09/18/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND In a multicultural society, the impact of language proficiency and interpreter use on critical care patient outcomes is unknown. OBJECTIVE To investigate the relationship between English language preference, requirement for an interpreter and in-hospital mortality amongst non-elective intensive care unit (ICU) patients. METHOD Adult patients admitted to all 23 public ICUs within the state of Victoria, Australia from July 2007 to June 2018, were extracted from The Australian New Zealand Intensive Care Society Adult Patient Database. De-identified patient data was matched using probabilistic methods and statistical linkage keys to the Victorian Admitted Episodes Database. Patients were classified into one of three groups: 'English preferred', 'English not preferred' and 'Interpreter required'. RESULTS 126,891 ICU admissions were analysed, of whom 3394 (3%) were in the 'English not preferred' group and 6355 (5%) in the 'Interpreter required' group. Compared to the 'English preferred', both the 'English not preferred' and 'Interpreter required' groups were older, had more co-morbidities and higher severity of illness scores. In-hospital mortality was 13.1% in the 'English preferred' group, 19.6% in the 'English not preferred' group and 16.7% in the 'Interpreter required' group. However, after adjusting for sex, severity of illness and socio-economic status, the 'English not preferred' group remained with a higher risk adjusted mortality (OR 1.21, 95%CI 1.07-1.36, P = 0.002), whereas the 'Interpreter required' group had a lower adjusted risk of mortality (OR 0.81, 95%CI 0.74-0.89, P < 0.001). CONCLUSION Being identified as having a requirement for an interpreter was associated with improved outcomes for adults admitted to public hospital ICUs in Victoria. Interpreter services should be more readily available in the hospital setting. It is recommended that patients, family members and clinicians actively use interpreter services when English is not the preferred language of an ICU patient.
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Affiliation(s)
- Andrea Duronjic
- The Department of Intensive Care Monash Health, Clayton, Victoria 3168, Australia.
| | - David Ku
- The Department of Intensive Care, Monash Health Dandenong, Victoria 3199, Australia; The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell Victoria, 3124, Australia
| | - Shaila Chavan
- The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell Victoria, 3124, Australia
| | - Tamara Bucci
- The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell Victoria, 3124, Australia
| | - Stephanie Taylor
- The Department of Intensive Care Monash Health, Clayton, Victoria 3168, Australia
| | - David Pilcher
- The Department of Intensive Care Medicine, The Alfred Hospital, Prahran, Victoria 3181, Australia; The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation, Camberwell Victoria, 3124, Australia; The Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Victoria 3004, Australia; Safer Care Victoria, Australia
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14
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Azua E, Fortier LM, Carroll M, Martin A, Mayorga S, Albino A, Lopez S, Chahla J. Spanish-Speaking Patients Have Limited Access Scheduling Outpatient Orthopaedic Appointments Compared With English-Speaking Patients Across the United States. Arthrosc Sports Med Rehabil 2023; 5:e465-e471. [PMID: 37101862 PMCID: PMC10123429 DOI: 10.1016/j.asmr.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/31/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose To evaluate whether Spanish-speaking patients can obtain appointments to outpatient orthopaedic surgery clinics across the United States at a similar rate as English-speaking patients and to examine the language interpretation services available at those clinics. Methods Orthopaedic offices nationwide were called by a bilingual investigator to request an appointment with a pre-established script. The investigators called in English asking for an appointment for an English-speaking patient (English-English), called in English requesting an appointment for a Spanish-speaking patient (English-Spanish), and called in Spanish asking for an appointment for a Spanish-speaking patient (Spanish-Spanish) in a random order. During each call whether an appointment was given, the number of days to the offered appointment, the mechanism of interpretation available in clinic, and whether the patient's citizenship or insurance information was requested was collected. Results A total of 78 clinics included in the analysis. There was a statistically significant decrease in access to scheduling an orthopaedic appointment in the Spanish-Spanish group (26.3%) compared with English-English (61.3%) or English-Spanish (58.8%) groups (P < .001). There was no significant difference in access to appointment between rural and urban areas. Patients in the Spanish-Spanish group who made an appointment were offered in-person interpretation 55% of the time. There was no statistically significant difference in time from call to offered appointment or the request for citizenship status between the 3 groups. Conclusions This study detected a considerable disparity regarding access to orthopaedic clinics nationwide in the individuals who called to establish an appointment in Spanish. Patients in the Spanish-Spanish group were able to make an appointment less often but had in-person interpreters available for interpretation services. Clinical Relevance With a large Spanish-speaking population in the United States, it is important to understand how lack of proficiency with the English language may affect access to orthopaedic care. This study uncovers variables associated with difficulties scheduling appointments for Spanish-speaking patients.
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Dahal R, Naidu J, Bajgain BB, Thapa Bajgain K, Adhikari K, Chowdhury N, Turin TC. Patient-Identified Solutions to Primary Care Access Barriers in Canada: The Viewpoints of Nepalese Immigrant Community Members. J Prim Care Community Health 2022; 13:21501319221141797. [PMID: 36476102 PMCID: PMC9742692 DOI: 10.1177/21501319221141797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature. METHODS We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis. RESULTS The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals. CONCLUSIONS Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants' primary care access.
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Affiliation(s)
- Rudra Dahal
- Nepalese-Canadian Community, Calgary, AB, Canada,University of Lethbridge, Lethbridge, AB, Canada
| | | | - Bishnu Bahadur Bajgain
- Nepalese-Canadian Community, Calgary, AB, Canada,University of Calgary, Calgary, AB, Canada
| | - Kalpana Thapa Bajgain
- Nepalese-Canadian Community, Calgary, AB, Canada,University of Calgary, Calgary, AB, Canada
| | - Kamala Adhikari
- University of Calgary, Calgary, AB, Canada,Alberta Health Services, Calgary, AB, Canada
| | | | - Tanvir C. Turin
- University of Calgary, Calgary, AB, Canada,Tanvir C. Turin, Department of Family Medicine, Cumming School of Medicine, University of Calgary, G012F, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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16
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Chalasani R, Krishnamurthy S, Suda KJ, Newman TV, Delaney SW, Essien UR. Pursuing Pharmacoequity: Determinants, Drivers, and Pathways to Progress. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:709-729. [PMID: 35867522 DOI: 10.1215/03616878-10041135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The United States pays more for medical care than any other nation in the world, including for prescription drugs. These costs are inequitably distributed, as individuals from underrepresented racial and ethnic groups in the United States experience the highest costs of care and unequal access to high-quality, evidence-based medication therapy. Pharmacoequity refers to equity in access to pharmacotherapies or ensuring that all patients, regardless of race and ethnicity, socioeconomic status, or availability of resources, have access to the highest quality of pharmacotherapy required to manage their health conditions. Herein the authors describe the urgent need to prioritize pharmacoequity. This goal will require a bold and innovative examination of social policy, research infrastructure, patient and prescriber characteristics, as well as health policy determinants of inequitable medication access. In this article, the authors describe these determinants, identify drivers of ongoing inequities in prescription drug access, and provide a framework for the path toward achieving pharmacoequity.
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Shiner CT, Bramah V, Wu J, Faux SG, Watanabe Y. Health care interpreter use in an inpatient rehabilitation setting: examining patterns of use and associated clinical outcomes. Disabil Rehabil 2022:1-11. [PMID: 35705483 DOI: 10.1080/09638288.2022.2086637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Professional interpreters can improve healthcare quality and outcomes when there is language discordance between patients and health care providers. Multidisciplinary rehabilitation relies on nuanced communication; however, the use of interpreters in rehabilitation is underexplored. This study aimed to examine patterns of health care interpreter use in an inpatient rehabilitation setting. METHODS A retrospective cohort study was conducted including patients admitted for subacute rehabilitation during 2019-2020 identified as having limited English proficiency. Patterns of interpreter use (professional and "ad hoc") and rehabilitation outcomes were evaluated via medical record review. RESULTS Eighty-five participants were included. During inpatient rehabilitation (median 17 [12-28] days), most clinical interactions (95%) occurred without an interpreter present. Patterns of interpreter use were variable; with greater use of ad hoc versus professional interpreters (received by 60% versus 49% of the cohort, respectively). Those who interacted with a professional interpreter had a longer length-of-stay, larger Functional Independence Measure (FIM) gain, and lower rate of hospital readmission six months post-discharge. The number of professional interpreter sessions correlated positively with FIM gain. CONCLUSIONS Access to professional interpreters in inpatient rehabilitation was variable, with some patients having no or minimal access. These findings provide preliminary evidence that professional interpreter use may be associated with clinical rehabilitation outcomes. Implications for rehabilitationProfessional health care interpreters can be used to overcome language barriers in rehabilitation.In an inpatient rehabilitation setting, professional interpreters appeared to be underutilized, with many patients having no or minimal access to interpreters.Use of ad hoc, untrained interpreters and informal communication strategies was common during rehabilitation.Use of professional interpreters appeared to be associated with favorable rehabilitation outcomes.
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Affiliation(s)
- Christine T Shiner
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Valerie Bramah
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Jane Wu
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
| | - Steven G Faux
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Yuriko Watanabe
- Department of Rehabilitation, St Vincent's Hospital Sydney, Darlinghurst, Australia
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Soleimani J, Marquez A, Fathma S, Weister TJ, Barwise AK. Detecting professional interpreter use among patients with limited English proficiency: Derivation and validation study. SAGE Open Med 2022; 10:20503121221098146. [PMID: 35600712 PMCID: PMC9118401 DOI: 10.1177/20503121221098146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 04/13/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives: The objective of this derivation and validation study was to develop and validate a search strategy algorithm to detect patients who used professional interpreter services. Methods: We identified all adults who had at least one intensive care unit admission during their hospital stay across the Mayo Clinic Enterprise between 1 January 2015 and 30 June 2020. Three random subsets of 100 patients were extracted from 60,268 patients to develop the search strategy algorithm. Two physician reviewers conducted gold standard manual chart review and any discrepancies were resolved by a third reviewer. These results were compared with the search strategy algorithm each time it was refined. Sensitivity and specificity were calculated during each phase by comparing the search strategy results to the reference gold standard for both derivation cohorts and the final validation cohort. Results: The first search strategy resulted in a sensitivity of 100% and a specificity of 89%. The second revised search strategy achieved a sensitivity of 100% and a specificity of 87%. The final version of the search strategy was applied to the validation subset and sensitivity and specificity were 100% and 89%, respectively. Conclusion: We derived and validated a search strategy algorithm to assess interpreter use among hospitalized patients. Using a search strategy algorithm with high sensitivity and specificity can reduce the time required to abstract data from the electronic medical records compared with manual data abstraction.
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Affiliation(s)
- Jalal Soleimani
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
- Amelia Barwise, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Alberto Marquez
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sawsan Fathma
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Timothy J Weister
- Anesthesia Clinical Research Unit (ACRU), Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amelia K Barwise
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Almanzar A, Martinez D, Vega E, Lopez M, Hodes-Villamar L, Sánchez JP. COVID-19 Education for Health Professionals Caring for Spanish-Speaking Patients. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2022; 18:11240. [PMID: 35497679 PMCID: PMC9001760 DOI: 10.15766/mep_2374-8265.11240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION The COVID-19 pandemic has disproportionately affected Hispanics in the United States, who make up 18% of US inhabitants but 29% of COVID-19 cases as of June 2021. Recent studies have attributed higher COVID-19 infection, hospitalization, and death rates among Hispanics to social determinants of health. Given that the majority of US Hispanics are bilingual or Spanish-dominant, it is imperative for health care providers to be prepared to discuss COVID-19 prevention and treatment in Spanish. METHODS We developed an interactive workshop aimed at increasing health professionals' confidence in discussing COVID-19 prevention, risk factors, and treatments with Spanish-speaking patients. Learners were expected to have an intermediate level or higher proficiency in medical Spanish. The workshop consisted of a PowerPoint presentation and English/Spanish scripts to facilitate interactive learning. The workshop was evaluated using a postworkshop questionnaire to assess learners' perceived confidence in communicating with Spanish-speaking patients. RESULTS The workshop was implemented with 70 participants, who had diverse ethnoracial identities and professional roles, at five different medical schools. Fifty-three participants completed the postworkshop questionnaire. More than 50% reported near complete to complete confidence in meeting the three learning objectives. DISCUSSION With Hispanics being the largest non-White ethnoracial group in the US and being disproportionally affected by COVID-19, it is essential for health professionals to access training tools that allow them to practice medical Spanish. This module can uniquely aid in the preparation of health professionals caring for Spanish-speaking patients who present with COVID-19 symptoms.
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Affiliation(s)
- Anibelky Almanzar
- Fourth-Year Medical Student, Northeast Ohio Medical University College of Medicine
| | - Derek Martinez
- First-Year Resident, Department of Emergency Medicine, University of Oklahoma College of Medicine
| | - Edgar Vega
- Fourth-Year Medical Student, University of California, San Diego, School of Medicine
| | - Miguel Lopez
- Fourth-Year Pharmacy Student, University of New Mexico College of Pharmacy
| | - Linda Hodes-Villamar
- Clerkship Director and Assistant Professor, Department of Emergency Medicine, University of New Mexico School of Medicine
| | - John Paul Sánchez
- Executive Associate Vice Chancellor, Diversity, Equity and Inclusion, Health Sciences Center, University of New Mexico School of Medicine
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20
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Stolarski AE, Alonso A, Aly S, Feeney T, Pereira F, Carter C, Hess D, Pernar LI, Carmine B, Drake FT. The impact of English proficiency on outcomes after bariatric surgery. Surg Endosc 2022; 36:7385-7391. [DOI: 10.1007/s00464-022-09148-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
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21
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Vidgen ME, Fowles LF, Istiko SN, Evans E, Cutler K, Sullivan K, Bean J, Healy L, Hondow G, McInerney-Leo AM, Pratt G, Robins D, Best S, Finlay K, Ramarao-Milne P, Waddell N. Evaluation of a Genetics Education Program for Health Interpreters: A Pilot Study. Front Genet 2022; 12:771892. [PMID: 35186003 PMCID: PMC8850313 DOI: 10.3389/fgene.2021.771892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022] Open
Abstract
Health Interpreters enable effective communication between health practitioners and patients with limited knowledge of the predominant language. This study developed and evaluated a training session introducing Health Interpreters to genetics. The online training was delivered multiple times as a single 2-h session comprising lectures and activities. Participants completed questionnaires (pre-, post-, and 6-months follow-up) to assess the impact of training on knowledge, attitude, self-efficacy, and self-reported practice behaviour. Questionnaires were analysed using descriptive statistics, Fisher’s Exact, or independent t-test. In total, 118 interpreters participated in the training sessions. Respondent knowledge improved, with gains maintained at 6-months (p < 0.01). There were no changes in self-efficacy, and attitudes. Training did not change self-reported practice behaviour, but there was notable pre-existing variability in participants’ methods of managing unknown genetic words. Most respondents agreed that training was useful (93%) and relevant (79%) to their work. More respondents reported learning more from the case study activity (86%) than the group activity (58%). Health Interpreters found the training acceptable and demonstrated sustained improvement in knowledge of genetic concepts. Increased delivery of this training and associated research is needed to assess findings in a larger cohort and to measure the impact on patients.
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Affiliation(s)
- Miranda E. Vidgen
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- *Correspondence: Miranda E. Vidgen,
| | - Lindsay F. Fowles
- Genetic Health Queensland, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Satrio Nindyo Istiko
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Erin Evans
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
- Health Consumers Queensland, Brisbane, QLD, Australia
| | - Katrina Cutler
- Queensland Genomics, The University of Queensland, Brisbane, QLD, Australia
| | - Kate Sullivan
- Queensland Genomics, The University of Queensland, Brisbane, QLD, Australia
| | - Jessica Bean
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Louise Healy
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Gary Hondow
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Aideen M. McInerney-Leo
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
- Dermatology Research Centre, The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Deborah Robins
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
| | - Stephanie Best
- Australian Genomics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Macquarie University, Sydney, NSW, Australia
| | - Keri Finlay
- Australian Genomics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Genetic Support Network of Victoria, Melbourne, VIC, Australia
| | - Priya Ramarao-Milne
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, QLD, Australia
| | - Nicola Waddell
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
- Queensland Genomics Community Advisory Group, The University of Queensland, Brisbane, QLD, Australia
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Calvillo-Ortiz R, Polanco-Santana JC, Castillo-Angeles M, Allar BG, Anguiano-Landa L, Ghaffarpasand E, Barrows C, Callery MP, Kent TS. Language Proficiency and Survival in Pancreatic Cancer: a Propensity Score-Matched Analysis. J Gastrointest Surg 2022; 26:94-103. [PMID: 34258672 DOI: 10.1007/s11605-021-05081-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited English proficiency has been shown to negatively affect health outcomes. However, as of now, little is known about survival rates of patients with limited English proficiency (LEP) and pancreatic ductal adenocarcinoma (PDAC) when compared to patients with English proficiency (EP) in an urban, non-safety net setting. We aimed to compare survival rates between patients with LEP and those with EP who had a diagnosis of PDAC. METHODS A single-institution retrospective propensity-matched cohort study of patients with biopsy-proven PDAC was undertaken. Demographics, clinical characteristics, and language information were collected for all participants. Patients were classified as having LEP or EP based on their preferred speaking language at the time of admission and matched on baseline characteristics using propensity scores. Survival analysis methods were used to study survival rates in patients with PDAC based on their EP status. RESULTS Of 739 included patients, 71 (9.48%) had LEP, mean age was 68.4 ± 10.9, and 51.8% were female. Both groups of patients were comparable for age, gender, marital status, and time to treatment. LEP status was associated with higher odds of death in both unmatched (HR 1.65, 95% CI 1.22-2.22) and matched (HR 1.60, 95% CI 1.03-2.47) analyses. Additionally, patients with LEP had significantly decreased odds of receiving cancer-directed treatment and increased odds of advanced stage cancer at presentation. CONCLUSIONS In this cohort of patients with PDAC, LEP predicted worse survival. The results of this study suggest that, after accounting for interpreter use, other factors contribute to this disparity. Such factors, as yet unmeasured, may include health literacy and cultural expectations, for which further investigation is warranted to better understand and limit this survival disparity.
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Affiliation(s)
- Rodrigo Calvillo-Ortiz
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - J Christopher Polanco-Santana
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - Manuel Castillo-Angeles
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - Luis Anguiano-Landa
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - Eiman Ghaffarpasand
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - Courtney Barrows
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - Mark P Callery
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 30 Brookline Avenue Palmer 6, Boston, MA, 02215, USA.
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Bomberg EM, Palzer EF, Rudser KD, Kelly AS, Bramante CT, Seligman HK, Noni F, Fox CK. Anti-obesity medication prescriptions by race/ethnicity and use of an interpreter in a pediatric weight management clinic. Ther Adv Endocrinol Metab 2022; 13:20420188221090009. [PMID: 35432917 PMCID: PMC9005816 DOI: 10.1177/20420188221090009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/04/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Race/ethnicity and low English proficiency healthcare disparities are well established in the United States. We sought to determine if there are race/ethnicity differences in anti-obesity medication (AOM) prescription rates among youth with severe obesity treated in a pediatric weight management clinic and if, among youth from non-primary English speaking families, there are differences in prescriptions between those using interpreters during visits versus not. METHODS We reviewed electronic health records of 2- to 18-year-olds with severe obesity seen from 2012 to 2021. Race/ethnicity was self-report, and AOMs included topiramate, stimulants (e.g. phentermine, lisdexamfetamine), naltrexone (±bupropion), glucagon-like peptide-1 agonists, and orlistat. We used general linear regression models with log-link to compare incidence rate ratios (IRRs) within the first 1 and 3 years of being followed, controlling for age, percent of the 95th BMI percentile (%BMIp95), number of obesity-related comorbidities (e.g. insulin resistance, hypertension), median household income, and interpreter use. We repeated similar analyses among youth from non-primary English speaking families, comparing those using interpreters versus not. RESULTS 1,725 youth (mean age 11.5 years; %BMIp95 142%; 53% non-Hispanic White, 20% Hispanic/Latino, 16% non-Hispanic black; 6% used interpreters) were seen, of which 15% were prescribed AOMs within 1 year. The IRR for prescriptions was lower among Hispanic/Latino compared to non-Hispanic White youth at one (IRR 0.70; CI: 0.49-1.00; p = 0.047) but not 3 years. No other statistically significant differences by race/ethnicity were found. Among non-primary English speaking families, the IRR for prescriptions was higher at 1 year (IRR 2.49; CI: 1.32-4.70; p = 0.005) in those using interpreters versus not. CONCLUSIONS Among youth seen in a pediatric weight management clinic, AOM prescription incidence rates were lower in Hispanics/Latinos compared to non-Hispanic Whites. Interpreter use was associated with higher prescription incidence rates among non-primary English speakers. Interventions to achieve equity in AOM prescriptions may help mitigate disparities in pediatric obesity.
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Affiliation(s)
| | - Elise F. Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D. Rudser
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Aaron S. Kelly
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Carolyn T. Bramante
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Hilary K. Seligman
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Favour Noni
- University of Minnesota, Minneapolis, MN, USA
| | - Claudia K. Fox
- Center for Pediatric Obesity Medicine, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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de Crescenzo C, Chen YW, Adler J, Zorigtbaatar A, Kirwan C, Maurer LR, Chang DC, Yeh H. Increasing Frequency of Interpreting Services is Associated With Shorter Peri-operative Length of Stay. J Surg Res 2021; 270:178-186. [PMID: 34688989 DOI: 10.1016/j.jss.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 08/25/2021] [Accepted: 09/16/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with limited English proficiency have barriers to accessing care. Rather than a binary use or no use, this study uses granular data on frequency of interpreting services to determine if this frequency is associated with differences in peri-operative length of stay for patients with limited English proficiency. MATERIALS AND METHODS This is a cross sectional study on length of stay for peri-operative admissions of at least one night during 2018, for patients who used medical interpreting services in an academic medical center in Boston, Massachusetts. The participants are split into quartiles of ascending number of interpreting events per day. The exposure for the primary outcome is the frequency of interpreting events per day during peri-operative admission. The primary study outcome measurement is peri-operative length of stay in days. RESULTS There was a statistically significant decrease in length of stay for patients in the highest two quartiles of interpreting service frequency, compared to the lowest quartile: quartile 2 trended shorter by 1.4 d (95% CI -4.5 to 1.7, P = 0.37), quartile 3 was 4.2 d shorter (95% CI -7.6 to -0.7, P = 0.02), and quartile 4 was 4.6 d shorter (95% CI -8.1 to -1.1, P = 0.01). CONCLUSIONS More frequent interpreting services per day during peri-operative admission are associated with shorter length of stay in adjusted analysis. The findings merit further study in an intervention to increase use of interpreting services for surgical patients with limited English proficiency to study the impact of increased frequency of culturally competent care.
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Affiliation(s)
- Claire de Crescenzo
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts.
| | - Ya-Wen Chen
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Joel Adler
- Department of Surgery, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts
| | - Anudari Zorigtbaatar
- Program in Global Surgery and Social Change at Harvard Medical School, Boston, Massachusetts; McGill Faculty of Medicine and Health Sciences, Montreal, QC, Canada
| | - Christopher Kirwan
- Medical Interpreter Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Lydia R Maurer
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Heidi Yeh
- Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
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Rhodes MG, Fletcher KE, Blumenfeld-Kouchner F, Jacobs EA. Spanish Medical Interpreters' Management of Challenges in End of Life Discussions. PATIENT EDUCATION AND COUNSELING 2021; 104:1978-1984. [PMID: 33563501 PMCID: PMC8217083 DOI: 10.1016/j.pec.2021.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Professional medical interpreters facilitate patient understanding of illness, prognosis, and treatment options. Facilitating end of life discussions can be challenging. Our objective was to better understand the challenges professional medical interpreters face and how they affect the accuracy of provider-patient communication during discussions of end of life. METHODS We conducted semi-structured interviews with professional Spanish medical interpreters. We asked about their experiences interpreting end of life discussions, including questions about values, professional and emotional challenges interpreting these conversations, and how those challenges might impact accuracy. We used a grounded theory, constant comparative method to analyze the data. Participants completed a short demographic questionnaire. RESULTS Seventeen Spanish language interpreters participated. Participants described intensive attention to communication accuracy during end of life discussions, even when discussions caused emotional or professional distress. Professional strains such as rapid discussion tempo contributed to unintentional alterations in discussion content. Perceived non-empathic behaviors of providers contributed to rare, intentional alterations in discussion flow and content. CONCLUSION We found that despite challenges, Spanish language interpreters focus intensively on accurate interpretation in discussions of end of life. PRACTICE IMPLICATIONS Provider training on how to best work with interpreters in these important conversations could support accurate and empathetic interpretation.
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Affiliation(s)
- Mary G Rhodes
- Department of Medicine, Medical College of Wisconsin, Milwaukee, USA.
| | - Kathlyn E Fletcher
- Department of Medicine, Medical College of Wisconsin, Milwaukee, USA; Department of Medicine, Clement J. Zablocki VA Medical Center, Milwaukee, USA.
| | - Francois Blumenfeld-Kouchner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, USA; Department of Palliative Care, Aurora Medical Group, Grafton Medical Center, Grafton, USA(1).
| | - Elizabeth A Jacobs
- Departments of Internal Medicine and Population Health, The University of Texas at Austin Dell Medical School, Austin, USA; Maine Medical Center Research Institute, MaineHealth, Portland, ME, USA(1).
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Pathak S, Gregorich SE, Diamond LC, Mutha S, Seto E, Livaudais-Toman J, Karliner L. Patient Perspectives on the Quality of Professional Interpretation: Results from LASI Study. J Gen Intern Med 2021; 36:2386-2391. [PMID: 33515189 PMCID: PMC7845580 DOI: 10.1007/s11606-020-06491-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of professional interpretation is associated with improvements in overall healthcare of patients with limited English proficiency (LEP). For these patients, it is important to understand whether quality of professional interpretation in-person is preserved using remote interpretation modalities (video-conferencing, telephone). OBJECTIVE To compare patient perceptions of professional interpretation quality delivered in-person, via video-conferencing, or via telephone during in-person primary care clinical visits. DESIGN Secondary analysis of a telephone survey conducted within 1 week after a primary care visit PARTICIPANTS: The 326 Chinese and Latino survey participants with LEP who reported using a professional interpreter-in-person, video medical conferencing (VMI), or telephone-during their visit MAIN MEASURES: Six items about the quality of interpretation: five detailed items scored as a scale, and a sixth overall quality item (range 1 = poor to 5 = excellent) KEY RESULTS: While there was a range for all modalities, most patients reported "very good" or "excellent" quality on both the scale and the overall single quality measure. In adjusted analysis, patients rated VMI quality the highest, followed by in-person and then telephone on both the 5-item scale (adjusted means: VMI 3.91, in-person 3.86, telephone 3.73) and the overall single quality item (adjusted means: VMI 3.94, in-person 3.85, telephone 3.83); however, no two-way comparisons were statistically significant (p values ranged 0.15-0.95). CONCLUSIONS Our results highlight that, overall, the interpretation experience among patients who used any type of professional interpretation was positive, and that the quality found with in-person interpretation is preserved for remote modalities. Health systems should consider a multimodality approach to interpreter service provision including options for accessing professional interpreters via all three modalities based on communication and access needs.
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Affiliation(s)
- Sarita Pathak
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lisa C Diamond
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Sunita Mutha
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Esme Seto
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.,Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Leah Karliner
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. .,Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Turin TC, Haque S, Chowdhury N, Ferdous M, Rumana N, Rahman A, Rahman N, Lasker M, Rashid R. Overcoming the Challenges Faced by Immigrant Populations While Accessing Primary Care: Potential Solution-oriented Actions Advocated by the Bangladeshi-Canadian Community. J Prim Care Community Health 2021; 12:21501327211010165. [PMID: 33882748 PMCID: PMC8072834 DOI: 10.1177/21501327211010165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Immigrants continue to face significant challenges in accessing primary healthcare (PHC) that often negatively impact their health. The present research aims to capture the perspectives of immigrants to identify potential approaches to enhance PHC access for this group. Methods: Focus group discussions (FGDs) were conducted among a sample of first-generation Bangladeshi immigrants who had experience with PHC in Canada. A total of 13 FGDs (7 among women, 6 among men) were conducted with 80 participants (women = 42, men = 38) in their preferred language, Bangla. We collected demographic information prior to each focus group and used descriptive statistics to identify the socio-demographic characteristics of participants. We applied thematic analysis to examine qualitative data to generate a list of themes of possible approaches to improve PHC access. Results: The focus group findings identified different levels of approaches to improve PHC access: individual-, community-, service provider-, and policy-level. Individual-level approaches included increased self-awareness of health and wellness and personal knowledge of cultural differences in healthcare services and improved communication skills. At the community level, supports for community members to access care included health education workshops, information sessions, and different support programs (eg, carpool services for senior members). Suggested service-level approaches included providers taking necessary steps to ensure an effective doctor-patient relationship with immigrants (eg, strategies to promote cultural competencies, hiring multicultural staff). FGD participants also raised the importance of government- or policy-level solutions to ensure high quality of care (eg, increased after-hour clinics and lab/diagnostic services). Conclusions: Although barriers to immigrants accessing healthcare are well documented in the literature, solutions to address them are under-researched. To improve healthcare access, physicians, community health centers, local health agencies, and public health units should collaborate with members of immigrant communities to identify appropriate interventions.
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Affiliation(s)
| | | | | | | | | | - Afsana Rahman
- Community-based citizen researcher, Calgary, AB, Canada
| | - Nafiza Rahman
- Community-based citizen researcher, Calgary, AB, Canada
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Rabinowitz DG. Caring for Non-English-Speaking Patients and Families During the COVID-19 Pandemic and Beyond. Hosp Pediatr 2021; 11:e104-e105. [PMID: 33986018 DOI: 10.1542/hpeds.2021-005893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Danielle G Rabinowitz
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts;
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; and
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
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Do Standardized Scripts Improve Interpreter Use by Spanish-Speaking Patients? J Immigr Minor Health 2021; 23:1021-1025. [PMID: 33837473 DOI: 10.1007/s10903-021-01195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2021] [Indexed: 10/21/2022]
Abstract
Patients with limited English-proficiency (LEP) who need but do not receive interpreters have lower satisfaction and poorer understanding. A knowledge gap remains regarding the optimal way to offer interpreters. Using standardized scripts, we will determine whether the questions we use to offer interpreters increase utilization. Pilot prospective cohort study of postpartum mothers with LEP. Subjects were assigned one of three unique scripted question offering an interpreter. Data were analyzed using ANOVA, chi-square test, and Fisher's exact test. Fifty-five LEP patients were randomized into three study arms with similar sociodemographics. Overall interpreter use was 80% (44/55). There was a significant difference in interpreter utilization: 82.4%, 63.6%, 100%, respectively by arm (p = 0.015). Highest interpreter utilization occurred with "In what language do you prefer to receive your medical care?". There is opportunity for providers to refine the way they offer interpreters to optimize utilization.
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Jallow M, Haith-Cooper M, Hargan J, Balaam MC. A systematic review to identify key elements of effective public health interventions that address barriers to health services for refugees. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01519-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hasan S, Faragallah A, Shanableh SD, Alebrahem SQ. Assessing the need for native language in pharmacy education and practice: a survey in the UAE. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:170-177. [PMID: 33729529 DOI: 10.1093/ijpp/riaa006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate pharmacists' opinions on the need for Arabic in pharmacy education and practice in the United Arab Emirates (UAE). METHODS A questionnaire was developed to address the study objectives and hand delivered to a stratified sample of community pharmacists and a convenience sample of pharmacists in other areas of practice in the UAE. Pharmacists' responses were measured on a 5-point Likert-type scale (strongly disagree to strongly agree) towards teaching of the following topics in Arabic: management of chronic diseases and minor ailments, screening for diseases and counselling on smoking cessation, exercise, weight management, diet and nutrition and complementary/alternative medicine. Topics related to communication skills were also assessed. Descriptive statistics on participant responses were calculated and chi-square test of independence examined inter-relationships among pharmacist and pharmacy variables. KEY FINDINGS A total of 351 pharmacists completed the questionnaire. Almost 50% of pharmacists considered Arabic in health sciences education a cultural and/or practice necessity. In pharmacy undergraduate curricula, preferred topics to be taught in Arabic included counselling on complementary/alternative medicine (67.4%), management of cold/flu (65.5%), counselling on weight management (64.2%), communication in special situations (63.2%), vocabulary (63.2%) and listening and empathic responding (62.6%). For continuing education, topics included management of cold/flu (69.8%) and skin conditions (69.2%), counselling on smoking cessation (68.9%), communicating with physicians and other professionals (54.8%), communication in special situations (54.7%) and vocabulary (50.9%). CONCLUSIONS For all assessed topics and communication skills, more than half of the pharmacists agreed that they needed to be included in pharmacy education. A blended learning approach that combines integrated content for native language within an English curriculum could be explored.
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Affiliation(s)
- Sanah Hasan
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Alaa Faragallah
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Sawsan Deeb Shanableh
- Department of Clinical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
| | - Sundos Qassim Alebrahem
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, Ajman University, Ajman, United Arab Emirates
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Scharf A, Voigt L, Vardhana S, Matsoukas K, Wall LM, Arevalo M, Diamond LC. What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably? AMA J Ethics 2021; 23:E97-108. [PMID: 33635189 DOI: 10.1001/amajethics.2021.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes. This article suggests strategies for clinicians trying to overcome linguistic and cultural barriers to equitable patient care.
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Affiliation(s)
- Amy Scharf
- Member of the ethics committee at Memorial Sloan Kettering Cancer Center in New York City
| | - Louis Voigt
- Associate professor of clinical medicine and anesthesiology at Weill Cornell Medical College in New York City
| | - Santosha Vardhana
- Medical oncologist at Memorial Sloan Kettering Cancer Center in New York City
| | - Konstantina Matsoukas
- Research informationist at the Memorial Sloan Kettering Cancer Center's Medical Library in New York City
| | - Lisa M Wall
- Clinical nurse specialist and ethics consultant at Memorial Sloan Kettering Cancer Center in New York City
| | - Maria Arevalo
- Clinical nurse at Memorial Sloan Kettering Cancer Center in New York City
| | - Lisa C Diamond
- Member of the research faculty of the Memorial Sloan Kettering Cancer Center Immigrant Health and Cancer Disparities Service
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Lee EK, Uppal K. CERC: an interactive content extraction, recognition, and construction tool for clinical and biomedical text. BMC Med Inform Decis Mak 2020; 20:306. [PMID: 33323109 PMCID: PMC7739454 DOI: 10.1186/s12911-020-01330-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Automated summarization of scientific literature and patient records is essential for enhancing clinical decision-making and facilitating precision medicine. Most existing summarization methods are based on single indicators of relevance, offer limited capabilities for information visualization, and do not account for user specific interests. In this work, we develop an interactive content extraction, recognition, and construction system (CERC) that combines machine learning and visualization techniques with domain knowledge for highlighting and extracting salient information from clinical and biomedical text. Methods A novel sentence-ranking framework multi indicator text summarization, MINTS, is developed for extractive summarization. MINTS uses random forests and multiple indicators of importance for relevance evaluation and ranking of sentences. Indicative summarization is performed using weighted term frequency-inverse document frequency scores of over-represented domain-specific terms. A controlled vocabulary dictionary generated using MeSH, SNOMED-CT, and PubTator is used for determining relevant terms. 35 full-text CRAFT articles were used as the training set. The performance of the MINTS algorithm is evaluated on a test set consisting of the remaining 32 full-text CRAFT articles and 30 clinical case reports using the ROUGE toolkit. Results The random forests model classified sentences as “good” or “bad” with 87.5% accuracy on the test set. Summarization results from the MINTS algorithm achieved higher ROUGE-1, ROUGE-2, and ROUGE-SU4 scores when compared to methods based on single indicators such as term frequency distribution, position, eigenvector centrality (LexRank), and random selection, p < 0.01. The automatic language translator and the customizable information extraction and pre-processing pipeline for EHR demonstrate that CERC can readily be incorporated within clinical decision support systems to improve quality of care and assist in data-driven and evidence-based informed decision making for direct patient care. Conclusions We have developed a web-based summarization and visualization tool, CERC (https://newton.isye.gatech.edu/CERC1/), for extracting salient information from clinical and biomedical text. The system ranks sentences by relevance and includes features that can facilitate early detection of medical risks in a clinical setting. The interactive interface allows users to filter content and edit/save summaries. The evaluation results on two test corpuses show that the newly developed MINTS algorithm outperforms methods based on single characteristics of importance.
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Affiliation(s)
- Eva K Lee
- Center for Operations Research in Medicine and HealthCare, School of Industrial and Systems Engineering, School of Biological Sciences, Georgia Institute of Technology, Atlanta, USA.
| | - Karan Uppal
- School of Medicine, Emory University, Atlanta, GA, USA
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Barriers to the use of trained interpreters in consultations with refugees in four resettlement countries: a qualitative analysis using normalisation process theory. BMC FAMILY PRACTICE 2020; 21:259. [PMID: 33278882 PMCID: PMC7719256 DOI: 10.1186/s12875-020-01314-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 11/12/2020] [Indexed: 11/18/2022]
Abstract
Background Increasing numbers of primary care practitioners in refugee resettlement countries are providing care to refugees. Access to trained interpreters is a priority for these practitioners, but there are many barriers to the implementation of interpreted consultations in routine care. There is a lack of international, theoretically informed research. The purpose of this paper is to understand barriers to interpreter use in primary care consultations in four resettlement countries using Normalisation Process Theory. Method We conducted a cross-sectional online survey with networks of primary care practitioners (PCPs) who care for refugees in Australia, Canada, Ireland and the US (n = 314). We analysed qualitative data from the survey about barriers to interpreter use (n = 178). We completed an inductive thematic analysis, iteratively developed a Normalisation Process Theory (NPT)-informed coding frame and then mapped the emergent findings onto the theory’s construct about enacting interpreted consultations. Results In all four countries, the use of an interpreter presented communication and interaction challenges between providers and patients, which can impede the goals of primary care consultations. Primary care practitioners did not always have confidence in interpreted consultations and described poor professional practice by some interpreters. There was variation across countries, and inconsistency within countries, in the availability of trained interpreters and funding sources. Conclusion There are shared and differential barriers to implementation of interpreted consultations in a consistent and sustained way in the four countries studied. These findings can be used to inform country-specific and international level policies and interventions focusing on improving skills and resources for interpreted consultations to improve implementation of interpreted primary care consultations. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01314-7.
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Führer A, Brzoska P. [The Importance of Language Interpretation in the Health Care System]. DAS GESUNDHEITSWESEN 2020; 84:474-478. [PMID: 33184807 DOI: 10.1055/a-1276-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many people in German-speaking countries have a limited proficiency in the German language. In the health care system, this may result in barriers to accessing and utilization of health services. The aim of this review was to present the current state of research on the relevance of language barriers in medical care and to explain strategies used to address language-related communication problems. METHODS The review is based on a synthesis of German- and English-language systematic reviews on the topic of 'language interpretation in the health care sector', including also all original papers from Germany published since 2015. RESULTS The most common method used in hospitals for language problems was interpretation by relatives of patients or by bilingual staff of the hospital. The quality of this language mediation by untrained laypersons was often limited, which can affect health care outcomes. Using professional interpreters was associated with significantly better health care outcomes and, particularly in the form of interpretation via telephone, was a flexible and cost-effective approach. CONCLUSION Language-based communication is an important prerequisite for patient-centered care and must be ensured by the health care system for ethical, social and legal reasons. In this context, professional interpretation solutions should be used, for which the required financial resources and infrastructure must also be made available.
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Affiliation(s)
- Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik, Profilzentrum Gesundheitswissenschaften, Martin-Luther-Universität Halle-Wittenberg, Halle
| | - Patrick Brzoska
- Lehrstuhl für Versorgungsforschung, Fakultät für Gesundheit/Department für Humanmedizin Universität Witten/Herdecke
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Lor M, Martinez GA. Scoping review: Definitions and outcomes of patient-provider language concordance in healthcare. PATIENT EDUCATION AND COUNSELING 2020; 103:1883-1901. [PMID: 32507590 DOI: 10.1016/j.pec.2020.05.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To conduct a scoping literature review to understand the conceptualization and nature of the research on patient-provider language concordance (LC) in health care. METHODS We searched PubMed, EMBASE, CINAHL, PsycINFO, and Scopus to identify peer-reviewed articles between January 1961 and August 2018. We extracted study characteristics, content, definitions, and findings. RESULTS Fifty studies were included. Forty studies were quantitative, seven were qualitative, and three were mixed methods. Overall, the studies revealed inconsistent definitions and measures of patient-provider LC. Outcomes studied in connection to LC included: (1) interpersonal relationships, (2) access to health information, (3) access to care, (4) satisfaction and health-care experience, and (5) patient-related health outcomes. While four studies found that LC care had a negative or no impact on health outcomes, 46 studies reported positive outcomes associated with LC care. CONCLUSIONS The study findings highlight the need for more research on LC care and a consistent definition of LC using multiple measures of LC to capture the complex and multidimensional nature of language in social interaction. PRACTICAL IMPLICATIONS The study findings highlight the importance of how ideologies of language shape the perceptions of language and LC, thereby influence resource allocation and priorities.
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Affiliation(s)
- Maichou Lor
- School of Nursing, University of Wisconsin-Madison, Madison, WI, United States.
| | - Glenn A Martinez
- Department of Spanish and Portuguese, Ohio State University, OH, United States.
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A systematic review of practice-, provider-, and patient-level determinants impacting Asian-Americans' human papillomavirus vaccine intention and uptake. Vaccine 2020; 38:6388-6401. [PMID: 32829979 DOI: 10.1016/j.vaccine.2020.07.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Asian-Americans have been documented to have low human papillomavirus (HPV) vaccine initiation and completion. No research has attempted to examine underlying mechanisms of HPV vaccine uptake disparities among Asian-Americans. Using the P3 (practice, provider, and patient) model, this study aimed to identify practice-, provider-, and patient-level determinants of Asian-Americans' HPV vaccine intention and uptake. METHODS We conducted a systematic review of published literature regarding practice-, provider- and patient-level determinants of vaccine intention (e.g., intention, willingness, or acceptability) and uptake (e.g., initiation or completion). Eligible studies were those presenting empirical/original data, focusing on Asian populations in the U.S., including outcomes related to HPV vaccine intention and uptake, and analyzing data on factors associated with these outcomes separately for Asian groups. RESULTS Twenty-six studies (19 quantitative and 7 qualitative studies) were included in the review. Most commonly studied subgroups were Koreans (n = 9), Chinese (n = 6), and Cambodians (n = 5). Studies showed varied prevalence across subgroups (intention: 23.4%-72%; initiation: 14%-67%; completion: 9%-63%). Only 3 studies included measurements of practice-level determinants (language services, insurance policy). Twelve studies measured provider-level determinants (most commonly documented: HPV vaccine recommendation). All studies measured patient-level determinants (most commonly documented: HPV and HPV vaccine knowledge, perceived safety, perceived susceptibility, and perceived relationship between HPV vaccine and sexual activity). CONCLUSIONS Existing research on determinants of HPV vaccine intention and uptake among Asian-Americans currently lacks measurements of practice-level constructs and perspectives of clinic staff and providers, which are needed to guide system-level interventions and provider training. Data regarding patient-level determinants suggest that interventions for Asian-American populations can focus on providing educational information in culturally-appropriate manners, leveraging familial influences, and attending to access-related or cultural beliefs about HPV vaccine. Interventions should take into account varied vaccine intention and uptake prevalence in different Asian subgroups.
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Bischoff A. The evolution of a healthcare interpreting service mapped against the bilingual health communication model: a historical qualitative case study. Public Health Rev 2020; 41:19. [PMID: 32774991 PMCID: PMC7401237 DOI: 10.1186/s40985-020-00123-8] [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] [Received: 01/08/2019] [Accepted: 04/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Twenty-five years ago, the need for health care interpreting in Switzerland increased due to the sharp influx of asylum seekers from war zones and countries of political unrest. Due to complex health needs, there was a need to move away from using volunteers as interpreters towards qualified interpreter services. Methods A historical qualitative case study design was used to describe the evolution of the language assistance programmes at Geneva University Hospitals, between 1992 and 2017. The aim was to map the evolution of the interpreter services against the Bilingual Health Communication Model with the constructs—Communicative Goals, Individual Agency, System Norms and Quality and Equality of Care—while identifying key factors to optimise interpreter service and patient care. Results and discussion Five phases were identified during the 25 years of service evolution studied: (1) Service initiation—the interpreter services were first used in a small service that cared for refugees and asylum seekers. (2) Growth and formalisation—due to the arrival of high numbers of Albanian-speaking asylum seekers, Albanian-speaking interpreters were provided to all departments of the Geneva University Hospitals. This helped roll out the use of interpreters among doctors and nurses. (3) Ensuring quality—the care for all patients, whether foreign-language speaking or not, became an issue and led to research into the quality of patient-provider communication. (4) Institutionalisation—this phase dealt with challenges including the lack of interpreter financing regulation and the clarification of interpreter roles. (5) Equity—healthcare interpreter services were put in an overall framework of equity standards. The Bilingual Health Communication Model was applied and showed that some items were not implemented: clear shifts (i) towards a culturally sensitive focus, (ii) towards community interpreting, (iii) towards triadic communication, (iv) towards spelling out the right to have an interpreter and (v) towards the involvement of insurance companies. Finally, the inclusion of healthcare interpreting as an essential ingredient in healthcare provision, including chronic disease management, is incomplete or missing. Conclusions Healthcare interpreting at Geneva University Hospitals has evolved from a ‘muddling-through’ approach towards an institutional approach by addressing quality of care, by focussing on the mental health of asylum seekers, training of both interpreters and users of interpreters and institutional policy based on equity.
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Affiliation(s)
- Alexander Bischoff
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Route des Cliniques 15, CH-1700 Fribourg, Switzerland.,Institute of Global Health, Faculty of Medicine, University of Geneva, 24 rue du Général-Dufour, 1211 Genève 4, Switzerland
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Shakya P, Sawada T, Zhang H, Kitajima T. Factors associated with access to HIV testing among international students in Japanese language schools in Tokyo. PLoS One 2020; 15:e0235659. [PMID: 32614904 PMCID: PMC7332052 DOI: 10.1371/journal.pone.0235659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 06/20/2020] [Indexed: 11/26/2022] Open
Abstract
Japan has been recognized for its excellent universal health coverage system. However, the migrant population faces many barriers in accessing health services in Japan. Japan hosts around 260,000 international students, mostly from developing countries. Among them, language school students tripled from 2011 to 2017, against the backdrop of labor shortage in Japan. Most of these students are also engaged as cheap laborers and are vulnerable populations with poor access to health services. Several socio-economic and behavioral factors may increase their vulnerability to HIV and prevent them from accessing HIV testing in Japan. We examined the factors associated with access to HIV testing among international students in language schools in Tokyo. We conducted a cross-sectional study among international students studying in Japanese language schools in Tokyo. We collected data from 769 Chinese, Vietnamese, and Nepalese students using a self-administered questionnaire. We measured their access to HIV testing through questions on their knowledge of where to receive HIV testing and utilization of HIV testing. Bivariate and multivariable logistic regression models were used to analyze the data. Nepalese students were less likely to know where to receive HIV testing in Japan than Chinese students (AOR = 0.12, 95% CI 0.01–0.96). Students who did not need Japanese language interpreters during visits to health facilities were more likely to know where to receive HIV testing (AOR = 1.93, 95% CI 1.14–3.25). Students who did not have knowledge of free and anonymous HIV testing in Japan were also less likely to know where to receive HIV testing in Japan (AOR = 0.18, 95% CI 0.08–0.42). Students who did not have knowledge of free and anonymous HIV testing (OR = 0.05, 95% CI 0.02–0.10) and who had not utilized HIV testing in their home country (OR = 0.12, 95% CI 0.06–0.27) were less likely to utilize HIV testing in Japan. Factors associated with access to HIV testing among Japanese language school students in Tokyo are nationality, need for Japanese language interpreters, perceived access to doctors/health workers, utilization of HIV testing in the home country, and knowledge of free and anonymous HIV testing. These findings may help to design interventions for improving access to HIV testing among international students in Japan.
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Affiliation(s)
- Prakash Shakya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of International Co-operation Studies, Kyorin University, Tokyo, Japan
- * E-mail:
| | - Takashi Sawada
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Minatomachi Medical Centre, Yokohama, Japan
| | - Hong Zhang
- Graduate School of International Co-operation Studies, Kyorin University, Tokyo, Japan
| | - Tsutomu Kitajima
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Graduate School of International Co-operation Studies, Kyorin University, Tokyo, Japan
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Al-Jumaili AA, Ahmed KK, Koch D. Barriers to healthcare access for Arabic-speaking population in an English-speaking country. Pharm Pract (Granada) 2020; 18:1809. [PMID: 32477432 PMCID: PMC7243745 DOI: 10.18549/pharmpract.2020.2.1809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services. Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript. Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits. Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.
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Affiliation(s)
- Ali A Al-Jumaili
- MPH, PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Kawther K Ahmed
- PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Dave Koch
- BS. Johnson County Public Health. Iowa City, IA (United States).
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Russell EA, Tsai C, Linton JM. Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020; 21:100779. [PMID: 32922213 PMCID: PMC7480259 DOI: 10.1016/j.cpem.2020.100779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
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Affiliation(s)
- Eric A Russell
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Carmelle Tsai
- Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie M Linton
- Department of Pediatrics and Assistant Dean for Admissions, University of South Carolina School of Medicine Greenville and Prisma Health Children's Hospital, Greenville, SC
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Mirza M, Harrison EA, Roman M, Miller KA, Jacobs EA. Walking the talk: understanding how language barriers affect the delivery of rehabilitation services. Disabil Rehabil 2020; 44:301-314. [DOI: 10.1080/09638288.2020.1767219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mansha Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth A. Harrison
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Marissa Roman
- Rehabilitation Sciences Program, University of Illinois at Chicago, Chicago, IL, USA
| | - Kathryn A. Miller
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Elizabeth A. Jacobs
- Departments of Population Health and Internal Medicine, University of Texas, Austin, TX, USA
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Van Keer RL, Fernandez SM, Bilsen J. Intercultural mediators in Belgian hospitals: Demographic and professional characteristics and work experiences. PATIENT EDUCATION AND COUNSELING 2020; 103:165-172. [PMID: 31349964 DOI: 10.1016/j.pec.2019.07.021] [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: 11/27/2018] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To investigate the 1) socio-demographic characteristics, 2) working environment, 3) tasks and responsibilities and 4) work experiences of intercultural mediators (IMs) working in Belgian hospitals. METHODS Cross-sectional quantitative survey among all IMs working in Flemish and Brussels hospitals (n = 66). Data were descriptively analyzed. Meaningful associations between variables were also studied. RESULTS Most IMs are young women from first- and second-generation migrant groups with different levels of education. They work under different superiors and most IMs are not employed full-time. They work mainly with patients from their own ethnic group. Mostly they intervene directly in daily intercultural communication, as per their official task description, but they also perform other tasks, such as offering support to patients/families/staff/management. IMs would prefer more of the tasks they perform to be formalized. Furthermore, they want to have policy-making responsibilities. IMs have positive and negative work experiences, e.g. working overtime. CONCLUSIONS IMs' socio-demographic characteristics (ethnic origin - sex - education) and official task description is only adapted to needs in the workplace to a limited extent. Furthermore, intercultural mediation is poorly integrated into hospitals' organizational structure. PRACTICE IMPLICATIONS Different measures are needed, including tailored education and offering IMs enough organizational support and policy responsibilities.
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Affiliation(s)
- Rose-Lima Van Keer
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Sarah Machado Fernandez
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group (MENT), Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 1090 Brussel, Brussels, Belgium.
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Williamson V, Borschmann R, Zimmerman C, Howard LM, Stanley N, Oram S. Responding to the health needs of trafficked people: A qualitative study of professionals in England and Scotland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:173-181. [PMID: 31483083 DOI: 10.1111/hsc.12851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/04/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
Trafficked people require timely and ongoing access to healthcare services. Yet, many encounter difficulties accessing and utilising healthcare services, both while in situations of exploitation and after their escape. This research investigated barriers that hinder healthcare providers from identifying, providing care and making necessary referrals for trafficked people in the United Kingdom (UK). Semi-structured, face-to-face interviews were conducted with healthcare (n = 23) and non-health (n = 27) professionals with relevant policy or practical experience related to human trafficking in the UK. Topic guides covered identifying, referring and providing care to trafficked people. Transcripts were analysed using thematic analysis. Four interconnected themes emerged: trafficked persons' entitlements to healthcare, availability of healthcare resources, providers' knowledge about trafficking, and the particular needs of trafficked individuals. Providers explained that policies limiting entitlements to healthcare created significant obstacles to care, as did the inadequate resourcing of interpreter services, trafficking support services, and specialist mental health services. Few healthcare professionals reported having received training on responses to trafficked people and most were unaware of support options and referral routes. Healthcare professionals will be better equipped to serve trafficked individuals if they are provided training to identify and respond to human trafficking, guidance on referral and support options and entitlements to care. Simultaneously, improving trafficked people's healthcare access and use will also require government interventions to ensure they are not unjustifiably denied healthcare.
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Affiliation(s)
- Victoria Williamson
- King's College London, King's Centre for Military Health Research (KCMHR), Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Vic., Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic., Australia
- King's College London, Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychiatry, The University of Melbourne, Melbourne, Vic., Australia
| | - Cathy Zimmerman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Louise M Howard
- King's College London, Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Nicky Stanley
- School of Social Work, Care and Community, University of Central Lancashire, Preston, UK
| | - Sian Oram
- King's College London, Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Jang Y, Kim MT. Limited English Proficiency and Health Service Use in Asian Americans. J Immigr Minor Health 2019; 21:264-270. [PMID: 29797103 DOI: 10.1007/s10903-018-0763-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The present study examined the extent to which limited English proficiency (LEP) poses a risk to health service use in Asian Americans. With data drawn from the 2015 Asian American Quality of Life Survey (N = 2594), logistic regression was used to model the odds for four outcomes (no usual place for care, no regular check-up, unmet needs for medical care, and communication problems in healthcare settings). More than 62% of the sample had LEP. In the group with LEP, the odds of not having usual place for care increased by 2.09 times, of not having regular check-up by 1.69 times, of having unmet needs for medical care by 1.89 times, and of having communication problems in healthcare settings by 4.95 times. The findings highlight the vulnerabilities of Asian Americans with LEP in health service use and provide implications for health planning and interventions.
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Affiliation(s)
- Yuri Jang
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Blvd., D 3500, Austin, TX, 78712, USA.
| | - Miyong T Kim
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
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Jaeger FN, Pellaud N, Laville B, Klauser P. Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare. BMC Health Serv Res 2019; 19:753. [PMID: 31653211 PMCID: PMC6815061 DOI: 10.1186/s12913-019-4628-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/11/2019] [Indexed: 11/16/2022] Open
Abstract
Background The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study. Methods Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies. Results 599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs. Conclusions Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.
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Affiliation(s)
- Fabienne N Jaeger
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland. .,Swiss Tropical and Public Health Institut, Socinstrasse 57, CH-4002, Basel, Switzerland. .,University of Basel, CH-4003, Basel, Switzerland.
| | - Nicole Pellaud
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland.,Swiss Society of Paediatrics, Rue de l'Hôpital 15, CH-1700, Fribourg, Switzerland
| | - Bénédicte Laville
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland
| | - Pierre Klauser
- Kollegium für Hausarztmedizin, Rue de l'Hôpital 15, CH-1701, Berne, Fribourg, Switzerland
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Singh K, Bestgen AN, Dugan A, Singh A, Kirby DF. Challenges to Delivering Home Parenteral Nutrition in Adult Patients With Limited English Proficiency. Nutr Clin Pract 2019; 34:850-857. [PMID: 31553083 DOI: 10.1002/ncp.10409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Failure to properly administer parenteral nutrition (PN) solutions can have deleterious effects on patients prescribed such therapies. The last few decades have seen diversification of the general population in the United States and elsewhere, with healthcare systems serving an increasing number of non-English-speaking patients and a more ethnically diverse population. Clinicians who provide care to this patient population encounter challenges in ensuring compliance and safe use of PN because of cultural and language barriers. Here we describe our experience of treating patients with limited English proficiency with respect to the barriers that prevent compliant and safe use of PN, especially in those discharged with home PN. We also describe the methods that we use to navigate these common issues to help clinicians provide the safest level of care to patients regardless of the patient's English proficiency.
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Affiliation(s)
- Kevin Singh
- Center for Human Nutrition, Digestive Disease and Surgery Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashley N Bestgen
- Center for Human Nutrition, Digestive Disease and Surgery Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Ann Dugan
- Center for Human Nutrition, Digestive Disease and Surgery Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Amandeep Singh
- Center for Human Nutrition, Digestive Disease and Surgery Institute, The Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Center for Human Nutrition, Digestive Disease and Surgery Institute, The Cleveland Clinic, Cleveland, Ohio, USA
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Greene NE, Fuentes-Juárez BN, Sabatini CS. Access to Orthopaedic Care for Spanish-Speaking Patients in California. J Bone Joint Surg Am 2019; 101:e95. [PMID: 31567810 DOI: 10.2106/jbjs.18.01080] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Communication is the foundation of any patient-doctor relationship. Patients who are unable to communicate effectively with physicians because of language barriers may face disparities in accessing orthopaedic care and in the evaluation and treatment of musculoskeletal symptoms. We evaluated whether Spanish-speaking patients face disparities scheduling appointments with orthopaedists via the telephone. METHODS From the American Academy of Orthopaedic Surgeons (AAOS) web site, we randomly selected 50 orthopaedic surgeons' offices in California specializing in knee surgery. The investigator called eligible offices using a script to request an appointment for a hypothetical Spanish-speaking or English-speaking 65-year-old man with knee pain. The caller randomly selected the patient's primary language for this first call. A second call was placed a week later requesting an appointment for an identical patient who spoke the alternate language. RESULTS There was no significant difference between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon (p = 0.8256). Thirty-six English-speaking patients and 35 Spanish-speaking patients were offered an appointment. Twenty-eight Spanish-speaking patients were instructed to bring a friend or family member who could translate for them, 3 were told that the provider spoke sufficient Spanish to communicate without the need for an interpreter, and 4 were told that an interpreter would be made available. CONCLUSIONS We did not detect a disparity between Spanish-speaking and English-speaking patients' access to appointments with an orthopaedic surgeon. However, 80% of Spanish-speaking patients were asked to rely on nonqualified interpreters for their orthopaedic appointment. This study suggests that orthopaedic offices in California depend heavily on ad hoc interpreters rather than professional interpretation services. It also highlights potential barriers to the provision of qualified interpreters. Additional study is warranted to assess how this lack of adequate utilization of medical interpreters affects the patient-doctor relationship, the quality of care received, and the financial burden on the health system. CLINICAL RELEVANCE Optimizing the care that we provide to our patients is a goal of every orthopaedic surgeon. We highlight the importance of utilizing professional interpreters as a means to reduce health-care disparities and overall health-care costs, as well as the importance of improving reimbursement and infrastructure for physicians to utilize qualified interpreters in caring for their limited-English-proficient patients.
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Affiliation(s)
- Nattaly E Greene
- School of Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Coleen S Sabatini
- Department of Orthopaedic Surgery, UCSF Benioff Children's Hospital Oakland, University of California, San Francisco, San Francisco, California
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White J, Plompen T, Tao L, Micallef E, Haines T. What is needed in culturally competent healthcare systems? A qualitative exploration of culturally diverse patients and professional interpreters in an Australian healthcare setting. BMC Public Health 2019; 19:1096. [PMID: 31409317 PMCID: PMC6693250 DOI: 10.1186/s12889-019-7378-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Culturally competent health care service delivery can improve health outcomes, increasing the efficiency of clinical staff, and greater patient satisfaction. We aimed to explore the experience of patients with limited English proficiency and professional interpreters in an acute hospital setting. Methods In-depth interviews explored the experiences of four culturally and linguistically diverse communities with regards to their recent hospitalisation and access to interpreters. We also conducted focus group with professional interpreters working. Data were analysed using an inductive thematic approach with constant comparison. Results Individual interviews were conducted with 12 patients from Greek, Chinese, Dari and Vietnamese backgrounds. Focus groups were conducted with 11 professional interpreters. Key themes emerged highlighting challenges to the delivery of health care due distress and lack of advocacy in patients. Interpreters struggled due to a reliance on family to act as interpreters and hospital staff proficiency in working with them. Conclusions In an era of growing ethnic diversity this study confirms the complexity of providing a therapeutic relationships in contemporary health practice. This can be enhanced by training towards the effective use of professional interpreters in a hospital setting. Such efforts should be multidisciplinary and collective in order to ensure patients don’t fall through the gaps with regards to the provision of culturally competent care. Electronic supplementary material The online version of this article (10.1186/s12889-019-7378-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer White
- School Primary and Allied Health Care, Monash University, Melbuorne, Victoria, Australia. .,School of Primary and Allied Health Care, Monash University, Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - Trish Plompen
- Partnerships & Service Design, Monash Health, Melbourne, Victoria, Australia
| | - Leanne Tao
- Partnerships & Service Design, Monash Health, Melbourne, Victoria, Australia
| | - Emily Micallef
- Partnerships & Service Design, Monash Health, Melbourne, Victoria, Australia
| | - Terrence Haines
- School Primary and Allied Health Care, Monash University, Melbuorne, Victoria, Australia
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Brandl EJ, Schreiter S, Schouler-Ocak M. Are Trained Medical Interpreters Worth the Cost? A Review of the Current Literature on Cost and Cost-Effectiveness. J Immigr Minor Health 2019; 22:175-181. [DOI: 10.1007/s10903-019-00915-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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