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Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children.

ABSTRACT: BACKGROUND:Achieving effective communication between medical providers and families with limited English proficiency (LEP) in the hospital is difficult. OBJECTIVE:Our objective was to identify barriers to and drivers of effective interpreter service use when caring for hospitalized LEP children from the perspectives of pediatric medical providers and interpreters. DESIGN/PARTICIPANTS/SETTING:We used Group Level Assessment (GLA), a structured qualitative participatory method that allows participants to directly produce and analyze data in an interactive group session. Participants from a single academic children's hospital generated individual responses to prompts and identified themes and relevant action items. Themes were further consolidated by our research team and verified by stakeholder groups. RESULTS:Four GLA sessions were conducted including 64 participants: hospital medicine physicians and pediatric residents (56%), inpatient nursing staff (16%), and interpreter services staff (28%). Barriers identified included: (1) difficulties accessing interpreter services; (2) uncertainty in communication with LEP families; (3) unclear and inconsistent expectations and roles of team members; and (4) unmet family engagement expectations. Drivers of effective communication were: (1) utilizing a team-based approach between medical providers and interpreters; (2) understanding the role of cultural context in providing culturally effective care; (3) practicing empathy for patients and families; and (4) using effective family-centered communication strategies. CONCLUSIONS:Participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. Future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.

SUBMITTER: Choe AY

PROVIDER: S-EPMC6817305 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children.

Choe Angela Y AY Unaka Ndidi I NI Schondelmeyer Amanda C AC Bignall Whitney J Raglin WJR Vilvens Heather L HL Thomson Joanna E JE

Journal of hospital medicine 20190724 10

<h4>Background</h4>Achieving effective communication between medical providers and families with limited English proficiency (LEP) in the hospital is difficult.<h4>Objective</h4>Our objective was to identify barriers to and drivers of effective interpreter service use when caring for hospitalized LEP children from the perspectives of pediatric medical providers and interpreters.<h4>Design/participants/setting</h4>We used Group Level Assessment (GLA), a structured qualitative participatory method ...[more]

PMID: 31339836

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Project description:ImportanceOften electronic tools are built with English proficient (EP) patients in mind. Cancer patients with limited English proficiency (LEP) experience gaps in care and are at risk for excess toxic effects if they are unable to effectively communicate with their care team.ObjectiveTo evaluate whether electronic patient-reported outcome tools (ePROs) built to improve health outcomes for EP patients might also be acceptable for LEP patients in the context of oral cancer-directed therapies (OCDT).Design, setting, and participantsThis qualitative study was conducted at a single National Cancer Institute-designated comprehensive cancer center. In 2019, English-speaking and Spanish-speaking LEP patients with cancer receiving oral chemotherapies were recruited to participate in a qualitative focus group examining patient attitudes toward ePROs and electronic tools that are used to manage adherence and symptoms related to oral therapies. Six focus groups were held for EP patients and 1 for Spanish-speaking LEP patients. LEP was defined as patients who self-identified as needing an interpreter to navigate the health care system. Data analysis was performed April through June of 2019.ExposuresEnrolled patients participated in a focus group lasting approximately 90 minutes.Main outcomes and measuresThe perspectives of patients with cancer treated with oral chemotherapies on integrating ePROs into their care management.ResultsAmong the 46 participants included in the study, 46 (100%) were White, 10 (22%) were Latinx Spanish-speaking, 43 (93%) were female, and 37 (80%) were aged at least 50 years or older. Among the 6 focus groups with 6 to 8 EP patients (ranging from 6 to 8 participants) and 1 focus group with 10 Spanish-speaking LEP patients, this qualitative study found that EP and LEP patients had different levels of acceptability of using technology and ePRO tools to manage their OCDT. EP patients felt generally positive toward OCDT and were not generally interested in using electronic tools to manage their care. LEP patients generally disliked OCDT and welcomed the use of technology for health management, particularly when addressing gaps in symptom management by their oncology clinicians.Conclusions and relevanceAlthough most electronic interventions target EP patients, these findings reveal the willingness of LEP patients to participate in technology-based interventions. Expanding ePROs to LEP patients may help to manage gaps in communication about treatment and potential adverse events because of the willingness of LEP patients to use ePRO tools to manage their health. This qualitative assessment is a strategic step in determining the resources needed to narrow the digital health gap and extend the value of PROs to the LEP oncology population.

Project description:BackgroundLimited English proficiency (LEP) is associated with poor health status and worse outcomes.ObjectiveTo examine disparities in hypertension between National Health and Nutrition Examination Survey (NHANES) respondents with LEP versus adequate English proficiency.DesignRetrospective analysis of multi-year survey data.ParticipantsAdults 18 years of age and older who participated in the NHANES survey during the period 2003-2012.Main measuresWe defined participants with LEP as anyone who completed the NHANES survey in a language other than English or with the support of an interpreter. Using logistic regression, we estimated the odds ratio for undiagnosed or uncontrolled hypertension (systolic blood pressure (SBP) > 140 mmHg or diastolic blood pressure (DBP) > 90 mmHg) among LEP participants relative to those with adequate English proficiency. We adjusted for sociodemographic, acculturation-related, and hypertension-related variables.Key resultsFourteen percent (n = 3,269) of the participants had limited English proficiency: 12.4% (n = 2906) used a Spanish questionnaire and 1.6% (n = 363) used an interpreter to complete the survey in another language. Those with LEP had higher odds of elevated blood pressure on physical examination (adjusted odds ratio [AOR] = 1.47 [1.07-2.03]). This finding persisted among participants using an interpreter (AOR = 1.88 [1.15-3.06]) but not among those using the Spanish questionnaire (AOR = 1.32 [0.98-1.80]). In a subgroup analysis, we found that the majority of uncontrolled hypertension was concentrated among individuals with a known diagnosis of hypertension (AOR = 1.80 [1.16-2.81]) rather than those with undiagnosed hypertension (AOR = 1.14 [0.74-1.75]). Interpreter use was associated with increased odds of uncontrolled hypertension, especially among patients who were not being medically managed for hypertension (AOR = 6.56 [1.30-33.12]).ConclusionsIn a nationally representative sample, participants with LEP were more likely to have poorly controlled hypertension than those with adequate English proficiency. LEP is an important driver of disparities in hypertension management and outcomes.

Project description:BackgroundThere are approximately 25.6 million individuals with limited English proficiency (LEP) in the USA, and this number is increasing.ObjectiveInvestigate associations between LEP and access to care in adults.DesignCross-sectional nationally representative survey.ParticipantsAdults with (n = 18,908) and without (n = 98,060) LEP aged ≥ 18 years identified from the 2014-2018 Medical Expenditure Panel Survey MAIN MEASURES: Associations between LEP and access to healthcare and preventive services were evaluated with multivariable logistic regression models, stratified by age group (18-64 and ≥ 65 years). The official government definition of LEP (answers "not at all/not well/well" to the question "How well do you speak English?") was used. Access to care included having a usual source of care (and if so, distance from usual source of care, difficulty contacting usual source of care, and provision of extended hours), visiting a medical provider in the past 12 months, having to forego or delay care, and having trouble paying for medical bills. Preventive services included blood pressure and cholesterol check, flu vaccination, and cancer screening.Key resultsAdults aged 18-64 years with LEP were significantly more likely to lack a usual source of care (adjusted odds ratios [aOR] = 2.48; 95% confidence interval [CI] = 2.27-2.70), not have visited a medical provider (aOR = 2.02; CI = 1.89-2.16), and to be overdue for receipt of preventive services, including blood pressure check (aOR = 2.00; CI = 1.79-2.23), cholesterol check (aOR = 1.22; CI = 1.03-1.44), and colorectal cancer screening (aOR = 1.58; CI = 1.37-1.83) than adults without LEP. Results were similar among adults aged ≥ 65 years.ConclusionsAdults with LEP had consistently worse access to care than adults without LEP. System-level interventions, such as expanding access to health insurance coverage, providing language services, improving provider training in cultural competence, and increasing diversity in the medical workforce may minimize barriers and improve equity in access to care.

Project description:BackgroundIndividuals with limited English proficiency (LEP) have worse healthcare access and report lower quality of care compared to individuals who are proficient in English. Policy efforts to improve patient-provider communication for LEP individuals have been going on for decades but linguistic disparities persist.ObjectiveTo describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015.DesignWe estimated interrupted time series models for three measures of patient-provider communication, testing for differences in both means (intercepts) and trends (slopes) before and after 2010 and differences in differences by English proficiency.ParticipantsA nationally representative sample of the US non-institutionalized population with at least one office-based medical visit from the 2006-2015 Medical Expenditure Panel Survey (N = 27,001).Main measuresPatient-provider communication is measured with three variables indicating whether individuals reported that their providers always explained things in a way that was easy to understand, showed respect for what they had to say, and listened carefully.Key resultsAlthough patient-provider communication improved for all groups over the study period, before 2010, it was getting worse among LEP individuals and disparities in patient-provider communication were widening. After 2010, patient-provider communication improved for LEP individuals and language disparities by English proficiency either narrowed or remained the same. For example, between 2006 and 2010, the percent of LEP individuals reporting that their provider explained things clearly declined by, on average, 1.4 percentage points per year (p value = 0.102); after 2010, it increased by 3.0 percentage points per year (p value = 0.003).ConclusionsOur study sheds light on trends in patient-provider communication before and after 2010, a year that marked substantial efforts to reform the US healthcare system. Though patient-provider communication among LEP individuals has improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.

Dataset Information

Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children.

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Inpatient Communication Barriers and Drivers When Caring for Limited English Proficiency Children.

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