Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers

Objective

We sought to compare emergency department (ED) use of professional interpreters in 2008 to previously reported 2002 data.

Methods

We surveyed consecutive adult patients for two 24-h periods at 4 Boston EDs in 2008. We used identical questions as in our 2002 study to assess English language barriers and to measure use and type of interpreter for those with language barriers.

Results

We enrolled 498 patients (66% of eligible). Of these, 8% had a significant English language barrier, but any interpreter was used for only 69% of these patients; the corresponding data for 2002 were 11% and 89%, respectively. In 2008, compared to 2002, professional interpreter use was similar (18% vs. 15%; p = 0.70), but a friend or family member interpreted more often (59% vs. 24%; p < 0.001), and hospital staff less often (10% vs. 47%; p < 0.001).

Conclusion

We found that use of professional interpreters by Boston ED patients with language barriers remained low, despite publicity of the state mandatory interpreter law. However, a majority were comfortable with a friend or family member serving as the interpreter for the clinical encounter, a finding that may contribute to the limited usage of professional interpreters.     

Language barriers between nurses and patients: A scoping review

ObjectiveGlobal migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers.MethodsA systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists.Results48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions.ConclusionGenerally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload.Practice ImplicationsThis review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.     

Using patient companions as interpreters in the Emergency Department: An interdisciplinary quantitative and qualitative assessment

ObjectivesTo explore the perceived and actual quality of communication and the conversational mechanisms through which misunderstandings arise in linguistically diverse Emergency Department consultations.MethodsA mixed method approach was used, based on audio-records of consultations which rely on patient companions for linguistic support, and ethnographic contextual data. Interpreting errors and their potential impact on the clinical reasoning process and doctor-patient relationships were quantitatively assessed. Complementary qualitative ethnographic research provided a richer understanding of the context. The study involved interdisciplinary collaboration with specialists in applied linguistics, medicine, and psychology.ResultsAccurate interpretation occurred in as few as 19% of interpreter speech turns. Answering for the patient and omitting information were the most frequent errors. The nature and severity of the impact of the errors varied. Answering for the patient had the greatest clinical impact. The omission of messages from the doctor to the patient negatively affected doctor-patient relationships.ConclusionGaps were observed between the perceived and the actual quality of communication, although patient companions often provided useful information.Practice implicationsIn addition to raising awareness among doctors on the potential risks of using AHIs, EDs should adjust their management to increase the utilization of onsite and remote PIs.     

Working with interpreters in health care: A systematic review and meta-ethnography of qualitative studies

Objective

To identify relational issues involved in working with interpreters in healthcare settings and to make recommendations for future research.

Methods

A systematic literature search in French and English was conducted. The matrix method and a meta-ethnographic analysis were used to organize and synthesize the data.

Results

Three themes emerged. Interpreters’ roles: Interpreters fill a wide variety of roles. Based on Habermas's concepts, these roles vary between agent of the Lifeworld and agent of the System. This diversity and oscillation are sources of both tension and relational opportunities. Difficulties: The difficulties encountered by practitioners, interpreters and patients are related to issues of trust, control and power. There is a clear need for balance between the three, and institutional recognition of interpreters’ roles is crucial. Communication characteristics: Non-literal translation appears to be a prerequisite for effective and accurate communication.

Conclusion

The recognition of community interpreting as a profession would appear to be the next step. Without this recognition, it is unlikely that communication difficulties will be resolved.

Practice implications

The healthcare (and scientific) community must pay more attention to the complex nature of interpreted interactions. Researchers need to investigate how relational issues in interpreted interactions affect patient care and health.     

Development and evaluation of the Communication over Language Barriers questionnaire (CoLB-q) in paediatric healthcare

Objective

To develop a valid and reliable questionnaire addressing the experiences of healthcare personnel of communicating over language barriers and using interpreters in paediatric healthcare.

Crossing borders, crossing cultures: barriers to communication about cancer prevention and treatment along the U.S./Mexico border

OBJECTIVE: To describe cultural barriers to cancer prevention and treatment efforts among Latinos living along the U.S./Mexico border. METHODS: In-depth interviews with 8 Mexican immigrants who are residents of a Texas colonia were conducted to understand the roles of culture and poverty in their experiences with cancer. Questions were asked about participants' cancer experiences, religiosity, medical establishment barriers, and cultural identity. Narrative and thematic analysis was used to highlight dialectical tensions inherent in the stories. RESULTS: The participants' narratives illustrate how poverty and Latino cultural beliefs create barriers to effective cancer prevention and treatment based on: (1) metaphysical beliefs about how they developed cancer and religious beliefs about how it was cured; (2) gender identity and treatment in the U.S. medical system and; (3) national/cultural identity and treatment in the U.S. medical system. CONCLUSION: Structural and cultural barriers interact in complex ways as low-income Latino/a patients and their families attempt to receive cancer care on the U.S./Mexico border. The manner in which these patients negotiate the tensions may reinforce barriers and inability to access health care and should be specifically addressed. PRACTICE IMPLICATIONS: Immigrant populations worldwide are especially vulnerable to health care disparities. Effective cancer prevention and treatment messages must be constructed to help patients and families reconcile cultural and economic tensions in ways that allow them maintain their identities but still receive the necessary health care.     

Language,literacy, and characterization of stroke among patients taking warfarin for stroke prevention: Implications for health communication

Objective

Warfarin is a medication commonly prescribed to prevent strokes associated with certain medical conditions such as atrial fibrillation; however, little is known about how people taking warfarin perceive the goal of therapy and how they describe strokes. We assessed the stroke-related health literacy of anticoagulated patients to inform ways in which to improve health communication among people taking warfarin.

Methods

We conducted a mixed-methods study of an ethnically and linguistically diverse sample of people taking warfarin to prevent stroke (N = 183) and measured literacy using the short-form Test of Functional Health Literacy in Adults. We asked participants to (1) describe their indication for warfarin, and (2) describe a stroke. Transcribed answers were coded as concordant or discordant with established indications for warfarin and definitions of stroke.

Results

Forty-three percent of participants provided a discordant response when describing their indication for warfarin. Only 9.3% reported that the purpose of taking warfarin was to prevent stroke. Not speaking English [OR = 2.4 (1.1–5.6)] and less than a college education [OR = 3.3 (1.4–7.3)] were independently associated with discordant answers about warfarin. Nearly 40% of subjects had inaccurate perceptions of stroke, and only one-third of subjects described a symptom or sign of stroke. Among English and Spanish-speaking participants, inadequate literacy was strongly associated with discordant responses about stroke [OR = 5.8 (2.1–15.6)].

Conclusion

Among high-risk people taking warfarin to prevent stroke, significant gaps in stroke-related health literacy exist. These gaps likely represent mismatches in the ways clinicians teach and patients learn.

Practice implications

Since stroke risk awareness and early recognition of the signs and symptoms of stroke are critical aspects of stroke prevention and treatment, clinicians should more strongly link warfarin therapy to stroke prevention and ensure that patients know the presenting symptoms and signs of stroke. Public health communication strategies regarding stroke prevention need to target individuals with limited literacy and limited English proficiency.     

Unmet information needs about the delivery of rheumatology health care services: a survey among patients with rheumatoid arthritis

Objective

To measure patient-perceived knowledge and information need regarding regional health care services and their determinants among 400 patients with rheumatoid arthritis (RA) and to identify the preferred method of information provision.

Methods

Postal survey on knowledge and information need (content and accessibility) of 18 regional health care services and preferences for the mode of delivery of information. Logistic regression analyses determined which factors were associated with insufficient knowledge and information need.

Results

Two-hundred and thirty-seven (94%) patients reported insufficient knowledge about the contents and 235 (94%) about the accessibility of at least one health care services, whereas 172 patients (69%) reported an information need about the content and 154 (61%) on the accessibility. Age was significantly associated with knowledge whereas both age and physical functioning were significantly associated with information need. Seventy-nine percent of the patients mentioned written information, 21% the Internet and 12% personal contact with a professional as a preferred method of information delivery.

Conclusion

Many RA patients reported a lack of knowledge or information need concerning the contents and accessibility of regional health care services.

Practice implications

Active strategies to provide practical information about health care services are needed for RA patients.     

The genesis,implementation and impact of the Better Access mental health initiative introducing Medicare‐funded psychology services

The Australian Government's Better Access to Mental Health Care initiative introduced mental health reforms that included the availability of Medicare‐funded psychology services. The mental health initiative has resulted in a huge uptake of these services, demonstrating the strong community demand for psychological treatment. The initiative has also had a substantial impact on the profile of the psychology profession. After a full year of implementation, analysis of the impact of the availability of funded psychology services identified a number of issues and challenges. However, it is evident that the inclusion of these services under Medicare has been a most important advance for the psychology profession and the mental health of the Australian community.     

Supporting the mental health needs of underserved communities: A qualitative study of barriers to accessing community resources

This study examined the accessibility of community resources (e.g., welfare programs and afterschool programs) for underserved youth and families with mental health needs. Mental health professionals (n = 52) from a large community mental health and welfare agency serving predominantly low-income, Latinx families completed a semistructured interview that asked about the accessibility of community resources. Participant responses were coded using an inductive thematic analysis. Results showed that 71% of participants endorsed availability barriers (e.g., limited local programs), 37% endorsed logistical barriers (e.g., waitlists), 27% endorsed attitudinal barriers (e.g., stigmatized beliefs about help-seeking), and 23% endorsed knowledge barriers (e.g., lacking awareness about local programs). Professionals' perceived availability barriers were mostly consistent with the actual availability of community resources. Findings highlight the compounding challenges that underserved communities face and point to opportunities for promoting enhanced well-being and functioning for youth and families with mental health needs.     

中国精神卫生服务及其政策:对1949-2009年的回顾与未来10年的展望

目的:对中国1949-2009年精神卫生服务提供模式和相关政策进行了系统回顾,分析不同发展阶段的特征,为我国精神卫生改革提供借鉴。方法:通过检索电子期刊数据库和我国卫生部官方网站等数据库并配合相应的手工检索,纳入收集整理与精神疾病流行病学、精神卫生服务提供、精神卫生服务利用、精神卫生政策和规划高度相关的资料。访谈国内外从事精神卫生服务工作的多名知名专家和主管领导,对其访谈内容记录、录音,进行归纳、分析、总结。结果:共纳入216篇文献,213人参与访谈。研究显示,60年来中国精神卫生资源和服务模式的演变经历了快速发展、稳步发展和改革等三个阶段;中国精神卫生服务体系在60年间发生了巨变化,但仍存在资源短缺、精神病治疗率较低、普通人群和医务人员精神卫生知识匮乏、社会对精神病人的偏见严重等现状;60年间,中国精神卫生服务政策也经历了巨大的变化,正向着建立以社区精神卫生服务为主的综合服务网络方向前进。结论:我国应继续强化社区卫生服务,提高精神卫生服务的公平性和可及性。     

The perimenopausal woman and her use of health services

This study investigated whether perimenopausal women had higher physician contact rates and a more negative self-assessment of their health than nonmenopausal women in the same 40–60 band. It also examined the relationship between subjective health status, physician contact rates and scores on a set of vasomotor and a set of psychological symptoms.One group of women were more likely to have seen a physician within the previous 2 wk, to report psychological symptoms and to take a negative view of their own health. However, perimenopausal women were no more likely to belong to this group than other women. Most perimenopausal women had seen a physician at least once in the preceding 12 mth, but were rarely women with high levels of physician contact.     

多水平模型在社区成人精神障碍现况及服务利用研究的应用(综述)

精神卫生流行病学调查多采用复杂抽样设计抽样方法,由此获得的数据具有多层次结构,使用传统的单水平多因素分析的方法会得出有偏差的结论。多水平模型把传统意义上来自生态学和个体水平上截然不同的两方面信息相结合,克服了只聚焦于单一水平的局限性,在众多领域得到了应用。本文综述了多水平模型在精神卫生领域两个方面应用的研究进展,即精神障碍影响因素研究及精神障碍患者卫生服务利用的影响因素研究,以期为未来多水平模型在精神卫生领域研究中的规范应用提供建议和参考。     

Differences in the use of outsourcing in public and private institutions providing medical services

Introduction

The costs of health care in Poland are continuously increasing. Thus, almost every institution providing medical services aims at their limitation. One of the costs rationalisation methods in the health care sector is outsourcing.

Material and methods

The study was conducted in 153 randomly selected institutions providing medical activities. The tool was a questionnaire, available via a web browser.

Results

Over 30% of public institutions identified the need for financial savings, as the main reason for outsourcing the cleaning function. Among private institutions, the dominant reason for this is too high maintenance cost of the cleaning staff (less than 40% of responses). The huge number of medical institutions use the services of an external company for laundering. Over 30% of public institutions identified as the most common reason for separation of functions laundering lack of resources to upgrade and modernize facilities. Less than 27% of public institutions indicate too high costs of kitchen staff as the main reason for ordering function of feeding. Another reason is the need for financial savings (22% response rate). Some institutions indicate a desire to focus on key areas (20% of responses) and lack of financial resources to upgrade and modernize the kitchen (20% response rate). Public and private institutions exercise control over the quality and method performed by an external service (71% of public institutions and 59% of private institutions). Private institutions often informally exercise external control (difference confirmed – Fisher''s exact test). Less than 90% of public institutions indicated satisfaction with the services provided by external companies.

Conclusions

The adaptation of outsourcing in medical facilities leads to financial efficiency improvement. Through the separation of some medical functions and entrusting their realisation to external companies, medical institutions can focus on their basic activity that is the provision of health services.