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Purpose We aimed to systematically review and meta-analyze published evidence on modes of communication between healthcare professionals and patients with hearing loss. Methods MEDLINE/PubMed, Scopus, CINAHL, ScienceDirect, and Thai Journals Online Complete databases were searched. A meta-analysis was performed using a random-effects model. Data on the prevalence and types of communication between healthcare professionals and patients with any extent of hearing loss were extracted. Results Twenty studies were included. Using a hearing aid (pooled prevalence, 57.4%; 95% CI, 11.4%-103.4%, N = 3, I 2 = 99.33) and gestures (pooled prevalence = 54.8%, 95%CI: 17.4% to 92.1%, N = 7, I 2 = 99.68) were the most commonly reported modes of communication. Few healthcare professionals could use sign language, and limited access to qualified interpreters was common. Conclusion Communication barriers exist. Qualified sign language interpreters and assistive technology should be used to improve communication. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Cardiovascular risk factors and history of cardiovascular disease are associated with greater morbidity and mortality in patients hospitalized with COVID-19. Limited English proficiency (LEP) has also been associated with worse outcomes in this setting, including requiring intensive care unit (ICU) level of care and in-hospital death. Whether non-- English-language preference (NELP) modifies the association between cardiovascular risk factors or disease and outcomes in patients hospitalized with COVID-19 is unknown. STUDY DESIGN: Retrospective cohort study of adult patients admitted to a large New England health system between March 1 and December 31, 2020, who tested positive for COVID-19. NELP was defined as having a preferred language that was not English noted in the electronic health record. METHODS: Cardiovascular risk factors, history of cardiovascular disease, and NELP were related to the primary composite clinical outcome--death or ICU admission--using multivariable binary logistic regression adjusted for demographic and clinical characteristics. Interaction terms for NELP and model covariates were evaluated. RESULTS: Of 3582 patients hospitalized with COVID-19, 1024 (28.6%) had NELP; 812 (79.3%) of the patients with NELP received interpreter services. Death or ICU admission occurred in 794 (22.2%) of the hospitalized patients. NELP was not significantly associated with the primary composite outcome in unadjusted or adjusted analyses. In the adjusted analyses, only male gender, coronary artery disease, pulmonary circulatory disease, and liver disease significantly predicted the primary outcome. NELP did not modify the effect of these associations. CONCLUSIONS: NELP was not significantly associated with odds of death or ICU admission, nor did it modify the association between cardiovascular risk factors or history of cardiovascular disease and this composite outcome. Because most patients with NELP received interpreter services, these findings may support the role of such services in ensuring equitable outcomes. [ABSTRACT FROM AUTHOR]

Manual co-speech gestures can facilitate language comprehension, especially in adverse listening conditions. However, we do not know whether gestures influence simultaneous interpreters' language comprehension in adverse listening conditions, and if so, whether this influence is modulated by interpreting experience, or by active simultaneous interpreting (SI). We exposed 24 interpreters and 24 bilinguals without interpreting experience to utterances with semantically related gestures, semantically unrelated gestures, or without gestures while engaging in comprehension (interpreters and bilinguals) or in SI (interpreters only). Tasks were administered in clear and noisy speech. Accuracy and reaction time were measured, and participants' gaze was tracked. During comprehension, semantically related gestures facilitated both groups' processing in noise. Facilitation was not modulated by interpreting experience. However, when interpreting noisy speech, interpreters did not benefit from gestures. This suggests that the comprehension component, and specifically crossmodal information processing, in SI differs from that of other language comprehension. [ABSTRACT FROM AUTHOR]

Background: Recognition of clinically deteriorating hospitalized patients with activation of rapid response (RR) systems can prevent patient harm. Patients with limited English proficiency (LEP), however, experience less benefit from RR systems than do their English-speaking counterparts. Objective: To improve outcomes among hospitalized LEP patients experiencing clinical deteriorations. Design: Quasi-experimental pre-post design using quality improvement (QI) statistics. Participants: All adult hospitalized non-intensive care patients with LEP who were admitted to a large academic medical center from May 2021 through March 2023 and experienced RR system activation were included in the evaluation. All patients included after May 2022 were exposed to the intervention. Interventions: Implementation of a modified RR system for LEP patients in May 2022 that included electronic dashboard monitoring of early warning scores (EWSs) based on electronic medical record data; RR nurse initiation of consults or full RR system activation; and systematic engagement of interpreters. Main Measures: Process of care measures included monthly rates of RR system activation, critical response nurse consultations, and disease severity scores prior to activation. Main outcomes included average post-RR system activation length of stay, escalation of care, and in-hospital mortality. Analyses used QI statistics to identify special cause variation in pre-post control charts based on monthly data aggregates. Key Results: In total, 222 patients experienced at least one RR system activation during the study period. We saw no special cause variation for process measures, or for length of hospitalization or escalation of care. There was, however, special cause variation in mortality rates with an overall pre-post decrease in average monthly mortality from 7.42% (n = 8/107) to 6.09% (n = 7/115). Conclusions: In this pilot study, prioritized tracking, utilization of EWS-triggered evaluations, and interpreter integration into the RR system for LEP patients were feasible to implement and showed promise for reducing post-RR system activation mortality. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study is to analyze an automated voice to text translation device by reporting the translation accuracy for recorded pediatric neurosurgery clinic conversations, classifying errors in translation according to their impact on overall understanding, and comparing the incidence of these errors in English to Spanish vs. Spanish to English conversations. Methods: English and Spanish speaking patients at a single academic health system's outpatient pediatric neurosurgery clinic had their conversations recorded. These recordings were played back to a Google Pixel handheld smartphone with Live Translate voice to text translation software. A certified medical interpreter evaluated recordings for incidence of minor errors, errors impacting understanding, and catastrophic errors affecting patient-provider relationship or care. Two proportion t-testing was used to compare these outcomes. Results: 50 patient visits were recorded: 40 English recordings translated to Spanish and 10 Spanish recordings translated to English. The mean transcript length was 4244 ± 992 words. The overall accuracy was 98.2% ± 0.5%. On average, 46 words were missed in translation (1.09% error rate), 31 understanding-altering translation errors (0.73% error rate), and 0 catastrophic errors were made. There was no significant difference in English to Spanish or vice versa. Conclusion: Voice to text translation devices using automatic speech recognition accurately translate recorded clinic conversations between Spanish and English with high accuracy and low incidence of errors impacting medical care or understanding. Further study should investigate additional languages, assess patient preferences and potential concerns with respect to device use, and compare these devices directly to medical interpreters in live clinic settings. [ABSTRACT FROM AUTHOR]

Many Alabamian Latinos/as/x experience limited English proficiency (LEP), creating a barrier to health care. Providers regularly work with medical interpreters to aid patients with LEP. This article brings the Alabama providers' perceptions of working with medical interpreters to light and examines strategies to improve care for patients with LEP. Objectives: Sixty-three percent of Latinos/as/x in Alabama, speak English "not well" or "not at all." Effective provider–patient communication is the foundation of successful clinical interactions. Medical interpretation is important to the healthcare provision for patients with limited English proficiency (LEP). We examined Alabama providers' perceptions of working with medical interpreters to identify strategies to improve healthcare provision for LEP patients. Methods: We conducted nine semistructured qualitative interviews with primary healthcare providers in western Alabama. We used NVivo to conduct thematic coding and content analysis. Results: Of the nine providers, one self-identified as Latina and the others identified as White. Four participants worked in community clinics and five worked at university-based clinics. Four themes emerged: preference for in-person interpreters over technology-based interpretation; providers' perceptions and expectations of the roles of professional interpreters; challenges in the communication process; and use of family members or other ad hoc interpreters. Conclusions: To meet the needs of Latino/a/x communities, clinical settings should invest in adequate staffing of in-person interpreters, infrastructure and workflow improvements, and the hiring and training of polylingual providers. Capacity-building opportunities to establish team building between interpreters and providers could be useful tools in improving healthcare provision for LEP patients. [ABSTRACT FROM AUTHOR]

Background: Patients with limited English proficiency (LEP) experience significant healthcare disparities. Clinicians are responsible for using and documenting their use of certified interpreters for patient encounters when appropriate. However, the data on interpreter use documentation in the emergency department (ED) is limited and variable. We sought to assess the effects of dot phrase and SmartPhrase implementation in an adult ED on the rates of documentation of interpreter use. Methods: We conducted an anonymous survey asking emergency clinicians to self-report documentation of interpreter use. We also retrospectively reviewed documentation of interpreterservices use in ED charts at three time points: 1) pre-intervention baseline; 2) post-implementation of a clinician-driven dot phrase shortcut; and 3) post-implementation of a SmartPhrase. Results: Most emergency clinicians reported using an interpreter "almost always" or "often." Our manual audit revealed that at baseline, interpreter use was documented in 35% of the initial clinician note, 4% of reassessments, and 0% of procedure notes; 52% of discharge instructions were written in the patients' preferred languages. After implementation of the dot phrase and SmartPhrase, respectively, rates of interpreter-use documentation improved to 43% and 97% of initial clinician notes, 9% and 6% of reassessments, and 5% and 35% of procedure notes, with 62% and 64% of discharge instructions written in the patients' preferred languages. Conclusion: There was a discrepancy between reported rates of interpreter use and interpreter-use documentation rates. The latter increased with the implementation of a clinician-driven dot phrase and then a SmartPhrase built into the notes. Ensuring accurate documentation of interpreter use is an impactful step in language equity for LEP patients. [ABSTRACT FROM AUTHOR]

Objective: Language brokering (LB) is an act of interpreting and translating that immigrants often engage in to help their family members who may not be fluent in the English language. The study examined whether adhering to Asian American values (ie, values enculturation) could moderate the association between LB and internalizing symptoms (eg, depression, anxiety) among Asian American college students. Participants & Methods: An online survey was administered to a sample of 159 Asian American college students who had engaged in LB. Results: Results from the moderation analysis indicated that Asian American values enculturation significantly buffered against the adverse effects of high LB frequency on internalizing symptoms after controlling for gender and generation status. Conclusions: The current study offered insights into the toll that LB could take on Asian American college students' mental health as well as the potential protective roles of values enculturation. [ABSTRACT FROM AUTHOR]

Introduction: To reduce COVID-19 exposure risk, virtual visits became widely adopted as a common form of healthcare delivery for the general population. It is unknown how this affected the deaf population, a sociolinguistic minority group that continues to face communication and healthcare barriers. The survey's objective was to describe the deaf participants' experiences with telehealth visits. Methods: A 28-item online survey, available in American Sign Language and English, was developed and disseminated between November 2020 and January 2021. Ninety-nine deaf participants responded. Descriptive statistics were performed to assess the participant's virtual health care use, experiences, and communication approaches. Results: Seventy-five percent of respondents used telehealth at least once in the past 12 months (n = 74; age = 37.6 ± 14.5 years). Of those who used telehealth, nearly two-thirds experienced communication challenges (65.3%; n = 49). Half of the participants reported having to connect via a video relay service that employs interpreters who maintain general certification instead of a remote interpreter with specialized health care interpreting certifications for video visits with their health care providers (n = 37) and a third of participants reported needing to use their residual hearing to communicate with their providers (n = 25). Conclusion: Standard protocols for health care systems and providers are needed to minimize the burden of access on deaf patients and ensure virtual visits are equitable. It is recommended these visits be offered on Health Insurance Portability and Accountability Act-compliant platforms and include multi-way video to allow for the inclusion of remote medical interpreters and/or real-time captionists to ensure effective communication between the provider and the deaf patient occurs. [ABSTRACT FROM AUTHOR]

Aphasia management can be challenging in multilingual settings. A lack of understanding of the needs and challenges faced by speech-language therapists (SLTs) might lead to insufficient capacity building and policymaking. To optimize aphasia rehabilitation, it is important to determine the current practices, needs, and challenges faced by SLTs in a multilingual context. This study aimed to explore how SLTs in Malaysia approach aphasia assessment and intervention for multilingual people with aphasia (PWA). Further, it aimed to identify the challenges SLTs experience, as well as the resources and strategies drawn upon to support the management of multilingual aphasia. Fifty participants who are SLTs in Malaysia completed an online questionnaire. The questionnaire consisted of four sections: Language Use; Aphasia Rehabilitation; Service Provision for Multilingual Clients with Aphasia; and Background Information. Five participants who took part in the survey also participated in the online focus group discussion. For the first study objective, it was found that participants primarily conducted individual aphasia interventions (100%), utilized informal tests of aphasia (~80%), and focused on improving language and social communication skills (~80%). More than half of the participants reported the experience of not sharing their clients' language and resorted to choosing a particular language for aphasia intervention. From the survey and FGD, participants indicated seeking assistance from family members to translate SLTs' questions and instructions during aphasia intervention. In addressing the second objective, language barriers and lack of appropriate resources were identified as two prominent challenges in multilingual aphasia management. For the third objective, participants suggested involving professional interpreters who are trained in assisting aphasia management to reduce language barriers. Developing tools and materials in multiple local languages and best practice guidelines were suggested for addressing the shortage of resources for multilingual aphasia management. Malaysian SLTs used rehabilitation approaches that were consistent with practices in other countries, such as the frequent use of informal approaches for aphasia assessments and the focus on improving language and communication skills of PWA. Challenges in aphasia rehabilitation in Malaysia were posed by several factors, including linguistic diversity and a lack of resources. There is a critical need to develop culturally and linguistically appropriate resources, including standardised assessment tools and best practice guidelines for multilingual aphasia rehabilitation. The involvement of professional interpreters in aphasia rehabilitation may enhance the quality of intervention. [ABSTRACT FROM AUTHOR]

Qualified language service providers (QLSPs)—professional interpreters or multilingual clinicians certified to provide care in another language—are critical to ensuring meaningful language access for patients. Designing patient-centered systems for language access could improve quality of pregnancy care. We synthesized and identified gaps in knowledge about communication preferences during pregnancy care among patients with Spanish primary language. We performed a scoping review of original research studies published between 2000 and 2022 that assessed communication preferences in Spanish-speaking populations during pregnancy care. Studies underwent title, abstract, and full-text review by three investigators. Data were extracted for synthesis and thematic analysis. We retrieved 1,539 studies. After title/abstract screening, 36 studies underwent full-text review, and 13 of them met inclusion criteria. Two additional studies were included after reference tracing. This yielded a total of 15 studies comprising qualitative (n = 7), quantitative (n = 4), and mixed-methods (n = 4) studies. Three communication preference themes were identified: language access through QLSPs (n = 7); interpersonal dynamics and perceptions of quality of care (n = 9); and information provision and shared decision-making (n = 8). Although seven studies reported a strong patient preference to receive prenatal care from Spanish-speaking clinicians, none of the included studies assessed clinician Spanish language proficiency or QLSP categorization. Few studies have assessed communication preferences during pregnancy care among patients with primary Spanish language. Future studies to improve communication during pregnancy care for patients with primary Spanish language require intentional analysis of their communication preferences, including precision regarding language proficiency among clinicians. [ABSTRACT FROM AUTHOR]

Language barriers are among the most critical factors in health care disparities. Low language proficiency is consistently associated with a high prevalence and severity of mental health disorder symptoms. Despite the advantages of working with an interpreter, most practitioners report difficulties, especially with trust and the feeling of control. The main objective of this exploratory qualitative intervention research is to examine the impact of training when working with interpreters and their inclusion in follow-ups. This impact is evaluated in the changes in feelings of control and trust for the practitioners who received the training, for the trained interpreters included in follow-ups and for the patients of these follow-ups. Semistructured interviews were conducted with individuals involved in five follow-ups at four public mental health clinics in Paris, France. The project had two phases: before (N = 18) and a few months after (N = 12) the training. Interviews were transcribed and thematically analyzed. Before the training, practitioners perceived the potential for collaboration with interpreters and the complexity of triadic consultations. Interpreters expressed irritation and disappointment at the lack of recognition, and patients seemed confident because they had already built a relationship with practitioners. After the training and inclusion of interpreters, trust is better established between interpreters and practitioners, which has substantial effects. All the protagonists state that trust positively impacts the relationship with patients and the therapeutic process. Although some practitioners still doubt the sessions' control, the intervention helps them to gain knowledge and critically examines their clinical modus operandi. Public Policy Relevance Statement: Employing an interpreter is the most effective way to overcome language barriers, yet mental health practitioners are reluctant to do so. This study shows that a few hours of training working with an interpreter not only enables practitioners to develop collaborative behaviors but also transforms the therapeutic process. Ensuring that practitioners have access to and know how to work with interpreters is key to improving access to care for highly vulnerable populations. [ABSTRACT FROM AUTHOR]

In the United States, 66 million people speak a language other than English at home. Patients with diverse language needs often face significant health disparities. Information and communication technologies have expanded the realm of modalities for patient-provider communication. However, the extent to which digital language access tools are utilized by healthcare providers is unknown. This research examines provider perspectives on language assistance techniques and the role of communication technology when serving patients with non-English language preference (NELP). Between April and July 2019, an online survey was administered to 3,033 healthcare providers (doctors, nurse practitioners, pharmacists, and dentists) in Washington State. Providers reported on their language access practices and perspectives on communication technology. Most providers reported using ad hoc language access techniques when engaging patients with NELP, such as a patient's family member or friend (75.8%), a patient's child specifically (61.9%), or a bilingual staff member (64.3%). Professional techniques, such as in-person interpretation (53.5%), phone interpretation (57%), and video remote interpretation (38.8%), were used less often. Dissatisfaction with the language access processes of healthcare providers' place of work was associated with a higher reliance on a patient's family or friend for language interpretation. Findings suggest that providers might be under-utilizing professional and digital interpreter services while relying on ad hoc techniques. Such practices reveal systemic constraints on language access that might make it difficult for providers to access timely and reliable options for professional language interpretation, despite federal regulations that mandate such services for patients with NELP. [ABSTRACT FROM AUTHOR]

Purpose: Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services. Method: Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries. Results: Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11- 3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity. Conclusions: The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision. [ABSTRACT FROM AUTHOR]

Medical interpretation is an underutilized resource, despite its legal mandate and proven efficacy in improving health outcomes for populations with low English proficiency. This disconnect can often be attributed to the costs and wait-times associated with traditional means of interpretation, making the service inaccessible and burdensome. Technology has improved access to translation through phone and video interpretation; with the acceleration of artificial intelligence (AI) large language models, we have an opportunity to further improve interpreter access through real-time, automated translation. The impetus to utilize this burgeoning tool for improved health equity must be combined with a critical view of the safety, privacy, and clinical decision-making risks involved. Physicians must be active participants and collaborators in both the mobilization of AI tools to improve clinical care and the development of regulations to mitigate harm. [ABSTRACT FROM AUTHOR]

Background: Global migration has led to a sharp increase in the number of language‐discordant consultations (LDCs) in healthcare. Evidence on how healthcare providers (HCPs) meet migrant patients' needs while mitigating language barriers is lacking. Design: Using purposive and snowball sampling, we recruited twenty‐seven Dutch HCPs (Mage = 45.07, SD = 11.46) and conducted semi‐structured interviews to collect qualitative, open‐ended data for identifying the communication strategies used with migrant patients in LDCs. We analysed the transcripts using deductive and inductive approaches (e.g., constant comparative method from Grounded Theory). Final pattern codes (i.e., key themes) were discussed among the research team until mutual agreement had been achieved. Results: Five key themes emerged from the analyses: HCPs often 'got‐by' with (1) instrumental and (2) affective communication strategies used in language‐concordant consultations to start medical consultations. When some instrumental communication strategies were deemed ineffective (e.g., lingua franca, gesturing, etc.) to bridge language barriers, HCPs turned to (3) incorporating digital tools (e.g., Google Translate). When HCPs were unable to communicate with migrant patients at all, (4) informal, ad‐hoc and professional interpreters were involved. Finally, HCPs often (5) involved additional support to engage migrant patients to engage in treatment‐related behaviours. Discussion and Conclusions: Our results highlight the importance of raising awareness among HCPs about using various combinations of different strategies. The development of a guideline indicating the optimal combination of communication strategies for different medical consultation goals may be useful in reshaping the current communication behaviour of HCPs in LDCs. Patient or Public Contribution: HCPs were the study population involved in this qualitative study. Refugee health advisors, general practitioners and linguistic specialists (i.e., members of the Right2Health consortium) with experience with the Dutch healthcare system were involved throughout the development of this research. This includes a review of the research question, participant information sheet and interview topic guide as well as providing interpretations of the data and feedback to this manuscript. [ABSTRACT FROM AUTHOR]

This paper presents a systematic literature review exploring the Family Group Conferencing experiences with racially minoritised families in England. The literature search identified eight qualitative studies that met the inclusion criteria. This review found that racially minoritised families felt that Family Group Conferencing was empowering and met their cultural needs at times, but suggested caution about how culturally adaptable the approach is for this population. We argue that FGC could be presented as an Indigenous model of engaging with family networks with relevance for social workers working with racially minoritised communities in England. We suggest that Family Group Conferencing aligns with aims of decolonisation and cultural competence and argue the need to explore how Indigenous knowledge can be valued more effectively in global social work debates. [ABSTRACT FROM AUTHOR]

Language barriers (LB) contribute to coronavirus disease 2019 (COVID-19) health inequities. People with LB were more likely to be SARS-CoV-2 positive despite lower testing and had higher rates of hospitalization. Data on hospital outcomes among immigrants with LB, however, are limited. We aimed to investigate the clinical outcomes of hospitalized COVID-19 cases by LB, immigration status, ethnicity, and access to COVID-19 health information and services prior to admission. Adults with laboratory-confirmed community-acquired COVID-19 hospitalized from March 1 to June 30, 2020, at four tertiary-care hospitals in Montréal, Quebec, Canada were included. Demographics, comorbidities, immigration status, country of birth, ethnicity, presence of LB, and hospital outcomes (ICU admission and death) were obtained through a chart review. Additional socio-economic and access to care questions were obtained through a phone survey. A Fine-Gray competing risk subdistribution hazards model was used to estimate the risk of ICU admission and in-hospital death by immigrant status, region of birth and LB Among 1093 patients, 622 (56.9%) were immigrants and 101 (16.2%) of them had a LB. One third (36%) of immigrants with LB did not have access to an interpreter during hospitalization. Admission to ICU and in-hospital mortality were not significantly different between groups. Prior to admission, one third (14/41) of immigrants with LB had difficulties accessing COVID-19 information in their mother tongue and one third (9/27) of non-white immigrants with a LB had difficulties accessing COVID-19 services. Immigrants with LB were inequitably affected by the first wave of the pandemic in Quebec, Canada. In our study, a large proportion had difficulties accessing information and services related to COVID-19 prior to admission, which may have increased SARS-CoV-2 exposure and hospitalizations. After hospitalization, a large proportion did not have access to interpreters. Providing medical information and care in the language of preference of increasing diverse populations in Canada is important for promoting health equity. [ABSTRACT FROM AUTHOR]

Working effectively with medical interpreters is an increasingly valuable skill for clinicians to provide high-quality medical care. We aimed to assess the effectiveness of existing training programs that teach optimal collaboration practices between clinicians and interpreters during patient encounters. We searched MEDLINE, EMBASE, Scopus, and Cochrane Central for studies published from 1945 through June 21, 2022. Out of the 1689 studies screened, we identified 19 studies that met inclusion criteria. Participants were from diverse professions, medical specialities, and training levels. Interpreter involvement in the development or delivery of the program was mentioned in 63% of the evaluated studies. There was substantial variability in training design, assessment methods, and reported outcomes. Only 10 of the programs included an objective knowledge or skills assessment. Only one study conducted a longitudinal assessment of skill maintenance over time. The training programs were generally well received. There is a critical need for structured programs to train clinicians to effectively collaborate with medical interpreters to reduce healthcare disparities. An effective training program should involve interpreters in the development and delivery of the program, practical skills development through interactive activities, structured clinical skill assessment, and both in-person and virtual components. [ABSTRACT FROM AUTHOR]

Objective: With the growing immigrant communities in the western world, there is an urgent need to address language barriers to care, and health disparities as a whole. Studies on limited English proficiency patients (LEP) have focused on patient perspectives of office visits, however little is known about health care provider perspectives of medical visits using interpretive services. We aimed to develop a pragmatic brief questionnaire for assessing providers' views of the quality of communication in outpatient visits with patients with LEP. The questionnaire was validated in a cross-sectional study (n = 99) using principal component analyses (PCA) with oblimin rotation. Internal consistency was analyzed using Cronbach's alpha. Results: Based on theory and literature, a seven-item scale was developed that captures two relevant concepts: (1) Provider - patient interaction during the consultation and (2) perceived quality of translation. The questionnaire was used to assess 99 LEP consultations and demonstrated good feasibility in a clinical setting. PCA revealed the two theory-based components with good factor loadings and internal consistency of α = 0.77. These preliminary results indicate that the questionnaire provides medical professionals with a validated tool to evaluate LEP patient encounters. Further confirmatory validation of the Provider-assessed Quality of Consultations with Language Interpretation (PQC-LI) in larger samples is warranted. [ABSTRACT FROM AUTHOR]

This study explored social workers' experiences of working with professional language interpreters in the disability sector with the goal of developing guiding principles for practice. Despite clients from diverse backgrounds increasingly accessing disability services, interpreter-mediated social work in the disability service context is an under-researched field. Six social workers participated in semistructured interviews. Findings suggest that social work with interpreters is a field of practice comprising practical and interactional challenges, requiring a high degree of professional discretion to optimise client outcomes. Emerging from the research are potential guiding principles for practice emphasising training, adaptability, interprofessional collaboration, person-centredness, and reflexivity. Interpreter-mediated social work in the disability sector presents unique challenges as a practice context. Interpreter-mediated social work is characterised by a complex professional inter-culture, requiring social workers and interpreters to mediate professional power and role negotiation to achieve effective service delivery. Guiding principles for practice may emphasise training, adaptability, interprofessional collaboration, person-centredness, and reflexivity. [ABSTRACT FROM AUTHOR]

A lack of diversity amongst participants in cancer clinical trials has raised scrutiny over the past decade. Patients with limited English proficiency (LEP) are further excluded. One modifiable reason for low LEP participation is a lack of non-English consent forms. We queried the clinical trials registry database at an academic hospital serving a predominantly Spanish-speaking patient population. Clinical trials related to gynecology oncology were evaluated for the availability of fully translated Spanish consent forms, the racial and ethnic identification of enrolled patients, and the number of signed Spanish consents. Enrolment data was compared before and after 2019, when institutional financial support for document translation was withdrawn. Sixteen gynecologic oncology clinical trials were opened between 2014 and 2022, with 10 trials enrolling 128 patients. Eight trials opened prior to 2019, all with fully translated consent forms. Seven of these trials enrolled 99 participants, 70% of whom identified as Hispanic and 60% who signed a Spanish consent. Eight trials opened after 2019 and one had a fully translated consent form. Three of the trials enrolled 29 participants, with 10% of subjects identifying as Hispanic and none signing a Spanish consent form. There was a decrease in fully translated clinical trial consent forms for gynecologic oncology studies following the loss of subsidized translation services in our single institution with a predominantly LEP population. This correlated with a decrease in enrollment of Hispanic subjects. To increase enrollment of diverse participants, including those with LEP, simple actions such as fully translating consent forms would help maintain equity in research conduct and improve clinical outcomes through trial involvement. [Display omitted] • Patients with limited English proficiency are underrepresented in clinical trials. • The simple act of translating consent forms can help maintain equity in trial enrollment. • Research institutions and industry should provide financial support towards translation services. [ABSTRACT FROM AUTHOR]

Background: This study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers. Methods: This study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels. Results: Four themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness. Conclusion: This is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS. [ABSTRACT FROM AUTHOR]

Assessments and treatments of mental health conditions such as depression use language that may be difficult to understand or translate. Here, we studied how interpreters assessed the usefulness of simplifying the language of a depression screen. Two alternative versions of the PRIME-MD PHQ depression screen were generated, with increasing linguistic simplicity. All the versions (standard, moderately simplified and most simplified) were translated from Finnish into Arabic, English, Farsi, Russian, and Swedish. Ten professional interpreters then assessed the different usefulness aspects of the three versions. The interpreters' perceptions of usefulness of the different language versions for clients varied, and both simplified versions of the depression screen were commonly considered useful for interpreting contexts. The usefulness of the simplified language versions was seen as especially important for clients with multiple linguistic challenges, caused by, for example, dementia and immigration backgrounds. The language of depression screens can be greatly simplified. Simplified versions may significantly improve the accessibility of questionnaires for the wide range of individuals with compromised language competence. Simplified versions may also be helpful for inter-language interpreting in health care, and importantly, they may facilitate the transparency and cross-cultural calibration needed in evidence-based medicine. [ABSTRACT FROM AUTHOR]

Background: Accurate information is essential so that HIV infection can be detected in time for initiation of HIV/AIDS treatment. Immigrants are at high risk for delayed HIV testing and diagnosis, but foreign residents in Japan also seem to face barriers to accessing HIV/AIDS care. We aimed to assess their knowledge level of HIV/AIDS and awareness of public health centers in Japan (PHCs), and to explore factors related to these items. Methods: We conducted a cross-sectional study of Brazilians, the largest group of foreigners living in Shiga, using an anonymous, self-administered questionnaire survey in Brazilian Portuguese and Japanese via the Internet and mail. A multiple logistic regression analysis was used to examine the factors related to "Knowledge of HIV/AIDS" and "Awareness of PHCs". Results: A total 182 Brazilians responded. More than half of them were beginners in Japanese. Most respondents were familiar with HIV/AIDS, but only 58% knew the existence of PHCs, and only 25% knew that HIV testing is available at PHCs free of charge and anonymously. A multiple logistic regression analysis showed that PHCs were less recognized by those with intermediate (odds ratio: 5.70, 95% confidence interval: 1.53–21.23) and beginner (odds ratio: 6.81, 95% confidence interval: 1.98–23.45) Japanese proficiency than by those with advanced. Conclusions: This survey revealed the knowledge level of HIV/AIDS and awareness of PHC among Brazilians in Shiga. Their lack of awareness of PHCs due to language barriers may lead to delays in HIV testing among them. Therefore, it is important for PHCs to disseminate information about medical services related to HIV/AIDS in Portuguese and plain Japanese to facilitate their access to HIV testing. However, PHC efforts alone are not enough. Medical interpreters who are familiar with Brazilian culture and customs, and the clinics that employ them, could help the Brazilian community and PHCs to overcome the language barrier and provide efficient and appropriate medical care to Brazilians. This would be one way to eliminate delays in HIV testing for Brazilians in Shiga. [ABSTRACT FROM AUTHOR]

We utilized a mixed methods design to analyze responses to a U.S.-distributed survey regarding early childhood professionals' (N = 1,047) use of culturally and linguistically responsive practices during the initial evaluation for early intervention or early childhood special education. Findings from the fully mixed concurrent equal status mixed methods design showed that personnel used some culturally and linguistically responsive evaluation practices, such as using interpreters and asking families about language use and routines at home. Other culturally and linguistically responsive evaluation practices were used by fewer than half of survey respondents. Participants noted a lack of bicultural and bilingual staff, training, materials, and other supports for implementing culturally and linguistically responsive evaluations. We discuss the need for ongoing efforts to ensure equitable access to early intervention and special education services for racially and linguistically marginalized young children. [ABSTRACT FROM AUTHOR]

Where a person with aphasia and the treating speech pathologist come from different linguistic backgrounds, an interpreter is often called upon to facilitate the clinical assessment. Previous research has documented the challenges that multilingual aphasia assessment can pose for both interpreter and speech pathologist. These challenges highlight the importance of interprofessional trust for an effective collaborative partnership. Our aim is to understand how provider-interpreter trust – as an activity-specific practice – develops through interactions in aphasia assessment sessions. Extracts from two interpreter-mediated aphasia assessments involving speakers of two different languages (Tagalog and Greek) were selected from a larger corpus. Using interactional sociolinguistic discourse analysis, we identified particular interactional choices and patterns that contributed to the building of rapport and trust between the interpreter and speech pathologist. Analysis revealed that participants invoked a range of interactive frames during the assessment sessions. Using the Framework of Provider-Interpreter Trust (Hsieh et al., 2010), we were able to demonstrate how socio-relationally oriented frames and clinically oriented frames can both serve the practice of trust building. Interactional features that reflect shared goals between the interpreter and speech pathologist, as well as acknowledgement of professional boundaries, can foster trust. We argue that there is scope for trust to be further enhanced by providing space for the interpreter to offer cultural insights relevant to the speaker's lifeworld that may be unfamiliar to the speech pathologist. We also argue that much of this work would be best achieved during dedicated pre-session briefings and post-session debriefings. [ABSTRACT FROM AUTHOR]

Children with cerebral palsy (CP) have an increased risk of cognitive difficulties and should be offered cognitive assessments. In Sweden, the CPCog protocol recommends children with CP undergo cognitive assessments at the start of primary and secondary school. To assess children with CP can be challenging, in particular when children are non-vocal or do not speak the local language. In such instances, augmentative and alternative communication (AAC) and qualified medical interpreters should be considered. The purpose of this study was to monitor the implementation and equitable delivery of the CPCog protocol in Sweden between the years 2017–2020. In this cross-sectional study, registry data were extracted from the combined follow-up program and national registry for individuals with CP (CPUP), and a convenience sample of psychologists responded to an online survey. Each year, less than 5% of eligible children had registered cognitive assessments in CPUP. There was underuse of AAC during assessments and a discrepancy between the registered versus reported use of interpreters. Psychologists perceived AAC as more reliable for cognitive assessments than interpreters. Greater availability of and capacity to offer cognitive assessments in other formats and languages could help increase test accessibility for all children with CP. The cognitive assessment of children with cerebral palsy (CP) is a complex but important issue within disability and re/habilitation. Individualized cognitive assessments should be offered and carried out by psychologists. Rehabilitation centers should strive to be inclusive through reliable test adaptations for functional abilities, means of communication, and language. Greater availability of- and capacity to offer cognitive assessments in more formats and languages could help increase test accessibility for children with disabilities. [ABSTRACT FROM AUTHOR]

This article considers how minoritisation features in Domestic Homicide Reviews (DHRs) in England and Wales and identifies critical learning in relation to addressing minoritisation. Five themes were identified: i) the invisibility of race, culture and ethnicity; ii) perceptions and experiences of services; iii) use of stereotypes and the culturalisation of domestic violence and abuse (DVA); iv) lack of interpreters; and v) DHR recommendations. Our analysis illustrates that statutory sector services should strengthen their responses to Black and minoritised victims by ensuring proper recording of cultural background is used to inform practice; engage professionally trained interpreters with an awareness of DVA; resist framing DVA as endemic to minoritised cultures; and enhance trust and confidence in public services within minoritised communities. The best examples of DHRs challenged service narratives and usually sought expertise from a specialist Black/minoritised DVA service or community organisation (frequently minoritised women's rights organisations). [ABSTRACT FROM AUTHOR]

The article discusses practices that ethicists can share with clinicians working with translators, according to Dr. Lewis J. Kaplan, professor of surgery at the Perelman School of Medicine at the University of Pennsylvania.

This article is a practice reflection of a social worker working with recent older refugees in Vancouver, Canada. Using an intersectionality lens, she will refer to four service areas to explain how recent older refugees can fall through the cracks. She will propose recommendations on practice at different levels. [ABSTRACT FROM AUTHOR]

Background: The importance of appropriate communication skills within a health care setting rests upon the need for effective information sharing. When successful, this provides a supportive working environment for staff and has a positive impact on patient care and outcomes. Aims: The purpose of this study was to explore how knowledge/evidence is acquired, shared, and applied in the Critical Care (CC) environment for staff and patients/family members. Study Design: A qualitative approach was used, consisting of semi‐structured interviews and focus groups. Data analysis was conducted using an iterative thematic approach. Results: Data collected prior to the COVID‐19 pandemic from United Kingdom (UK) critical care workers (N = 46), patients, and family members (N = 21) identified four communication roles performed by the nursing staff: team member; diplomat; translator and friend. Conclusions: It was evident that without suitable training and support, the stresses and demands placed upon the nurses could lead to disenfranchisement and burnout. Relevance to Clinical practice: These findings are relevant and timely given the impact of the pandemic, highlighting the need for accessible and alternate communication strategies to support nurses by reducing stress, moral distress and increasing psychological safety. Improved communication can provide tailored information for staff and patients/family improving the CC experience for all. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore Spanish-speaking patients' experiences and preferences regarding communication during pregnancy care with specific attention to language barriers. METHODS: Patients with a Spanish language preference who gave birth between July 2022 and February 2023 at an academic medical center were invited to participate in focus groups. Focus groups were held over Zoom, audiorecorded, transcribed in Spanish, translated into English, and reviewed for translation accuracy. Thematic analysis was conducted with deductive and inductive approaches. Three investigators double-coded all transcripts, and discrepancies were resolved through team consensus. RESULTS: Seven focus groups (27 total participants, range 2-6 per group) were held. Three key themes emerged regarding patient experiences and communication preferences when seeking pregnancy care: 1) language concordance and discordance between patients and clinicians are not binary--they exist on a continuum; 2) language-discordant care is common and presents communication challenges, even with qualified interpreters present; and 3) language discordance can be overcome with positive interpersonal dynamics between clinicians and patients. CONCLUSION: Our findings highlight the importance of relationship to overcome language discordance among patients with limited English proficiency during pregnancy care. These findings inform potential structural change and patient-clinician dyad interventions to better meet the communication needs of patients with limited English proficiency. [ABSTRACT FROM AUTHOR]

For some languages, there a handful of professional healthcare interpreters serving hospitals and healthcare systems across the country remotely by video or phone. When language-concordant care is not possible, healthcare systems must recognize that engaging professional healthcare interpreters may incur upfront costs associated with longer consultations and perceived lower physician productivity. Yet it is common for bilingual family members or healthcare team members who are not trained in healthcare interpretation to interpret during clinical encounters.[[18]] Patients and care team members may not recognize how care and communication break down with ad hoc interpretation by untrained individuals. Medical errors are more common when no interpreter is used for patients with NELP as well as when ad hoc interpreters lacking formal healthcare interpretation training are used compared to when professional healthcare interpreters are engaged in the care of patients with NELP.[17] Reducing medical errors through the use of professional healthcare interpreters exemplifies non-maleficence. [Extracted from the article]

Objective: This article provides an overview of the implications of ChatGPT and other large language models (LLMs) for dental medicine. Overview: ChatGPT, a LLM trained on massive amounts of textual data, is adept at fulfilling various language‐related tasks. Despite its impressive capabilities, ChatGPT has serious limitations, such as occasionally giving incorrect answers, producing nonsensical content, and presenting misinformation as fact. Dental practitioners, assistants, and hygienists are not likely to be significantly impacted by LLMs. However, LLMs could affect the work of administrative personnel and the provision of dental telemedicine. LLMs offer potential for clinical decision support, text summarization, efficient writing, and multilingual communication. As more people seek health information from LLMs, it is crucial to safeguard against inaccurate, outdated, and biased responses to health‐related queries. LLMs pose challenges for patient data confidentiality and cybersecurity that must be tackled. In dental education, LLMs present fewer challenges than in other academic fields. LLMs can enhance academic writing fluency, but acceptable usage boundaries in science need to be established. Conclusions: While LLMs such as ChatGPT may have various useful applications in dental medicine, they come with risks of malicious use and serious limitations, including the potential for misinformation. Clinical Significance: Along with the potential benefits of using LLMs as an additional tool in dental medicine, it is crucial to carefully consider the limitations and potential risks inherent in such artificial intelligence technologies. [ABSTRACT FROM AUTHOR]

With 20% of Canadians reporting a mother tongue other than English or French, it is not uncommon for health professionals and patients to be proficient in different languages. When a physician and patient cannot properly communicate, there is potential for misunderstanding, which can lead to poor clinical outcomes and hospital readmission. Professional interpretation services are associated with improved communication, health care use, clinical outcomes, and satisfaction with care. Using untrained or ad hoc interpreters—including family members—has been shown to increase errors of omission, substitution, editorialization, and addition. Children and youth are not sufficiently developmentally mature to act as interpreters in health care. Using children and youth as interpreters in health care settings places them in an inappropriate and potentially difficult situation that may have lasting negative effects on both their own mental health and their relationships with other family members. [ABSTRACT FROM AUTHOR]

Background: This research is inspired by the challenges encountered in interpreter training, changes in learning needs in the technological era, the educational paradigm shift caused by the COVID‐19 pandemic, the lack of studies on combining virtual reality (VR)_and mobile technologies, and literature gaps in the field of the incorporation of technology in interpreter education. Objectives: This research aims to develop a mobile‐based VR application for bi‐directional English‐Chinese and Chinese‐English interpreting learning named 'Virtual Interpreting Practice' (VIP) based on an interpreting competence model and to investigate its impact on students' self‐rated language and interpreting proficiency levels as well as their declarative knowledge and operative skills as reflected in different interpreting modes (sight and consecutive) and language directions (English‐Chinese and Chinese‐English). The VIP app contains learning resources, including 13 learning modules covering both interpreting modes, practical topics and contexts, video lectures and demonstrations, fully immersive VR and non‐VR practice, glossary lists, source texts, translated texts and an online feedback platform. Methods: Thirty‐one native Chinese‐speaking English as a second/foreign (ESL/EFL) undergraduate students used the app for self‐directed learning. The data were collected by the pre‐study and post‐study questionnaires as well as the pre‐test and post‐test. Results and Conclusions: The results indicate that the use of VIP significantly raised the students' self‐rated language and interpreting proficiency levels as well as their interpreting performance in both modes and language directions. While the students performed better in sight interpreting and Chinese‐English interpreting, they achieved a significantly higher improvement rate in consecutive interpreting and English‐Chinese interpreting. Lay Description: What is already known about this topic: A number of studies have demonstrated the use of virtual reality (VR) provides users with senses of multiple presence, enhances learner engagement and motivation, and facilitates collaborative, situated, immersive and experiential learning that is not often available in traditional learning environments.The increasing availability of VR has created new opportunities in the area of mobile‐assisted language learning (MALL), paving the way for a new research area called VR‐assisted language learning (VRALL).Using VRALL, numerous benefits in various language skills have been identified, such as listening, speaking, writing and vocabulary acquisition. What this paper adds: While blending VR and mobile technologies may play a more significant role in education settings and create more advantages, the impact of this combination for interpreting learning has remained an unexplored area in higher education. This paper has addressed the research gaps in which there is a lack of VR language learning apps that are bilingual, mobile‐based and specifically designed for interpreting practice in highly immersive learning environments.The results indicate that the use of VIP significantly raised the students' self‐rated language and interpreting proficiency levels as well as their interpreting performance in both sight and consecutive interpreting and language directions (English‐Chinese and Chinese‐English).While the students performed better in sight interpreting and Chinese‐English interpreting, they achieved a significantly higher improvement rate in consecutive interpreting and English‐Chinese interpreting. Implications for practice and/or policy: The results have implications for the roles of students and teachers. The app developed in this study shifts the teacher‐led approach to student‐centred learning. While it allows more learning autonomy, its effectiveness may largely depend on students' ability to self‐regulate and engage.It appears that the effectiveness of VRALL depends on a number of individual and contextual factors, e.g. the design and functionality of the apps, availability of the internet connection and smartphones as well as learning needs and motivation. [ABSTRACT FROM AUTHOR]

Children can need the help of an interpreter if they are victims of a crime and need to be forensically interviewed in another language. Recent findings from practitioners raise concerns about the state of interpreter-mediated interviews with children. The current study aimed to explore how Swedish criminal courts reason when assessing interpreter-mediated and interpreter-absent (with children who are not fluent in Swedish) child investigative interviews. We conducted qualitative and descriptive analyses of written court verdicts involving 108 child victims who were evaluated to need an interpreter during their investigative interview. The courts frequently discussed issues regarding possible misinterpretations, language difficulties, and confusion. These perceived deficiencies in the interviews were often mentioned as a cause for assessing the child's testimony with caution and, in some cases, as lowering the evidential value of the child interview. Possible implications for children's legal rights are discussed. [ABSTRACT FROM AUTHOR]

Previous research has demonstrated that without the use of professional interpreters, language barriers interfere with patient care. The literature recommends documenting the presence of language barriers in medical charts. To our knowledge, this mixed methods study is the first to examine language documentation practices in a Canadian inpatient psychiatry setting. The research team interviewed 122 patients admitted to a tertiary care psychiatry ward in Montreal, Canada between 2016−2017 to assess their ability to communicate in the healthcare establishment's languages (English/French). Nineteen participants identified as having a language barrier were selected for a qualitative analysis of the retrospective audit of their medical charts. The presence of a language barrier was reflected in 68% of these charts. When a language barrier was documented, professional interpreters were never used. Our qualitative analysis, informed by literature on medical discourse, aimed to provide clinical, administrative, and organizational recommendations to optimize the utilization of interpreting services in psychiatric wards. Documentation of language data was inconsistently collected, often vague, and shed light on the clinical challenges involved in differentiating language barriers from psychopathology. Normalization of limited care for language diverse patients was reflected in the clinical notes. Findings show that a change of organizational culture is imperative to provide optimal care to language diverse patients. We recommend clinician education and standardization of documentation practices, along with institutional policies supporting the systematic use of professional interpreters in mental healthcare settings, to maximize human rights and patient safety, and to bring medical practices to an acceptable standard of care. [ABSTRACT FROM AUTHOR]

Aim: To compare access to the initial management and overall survival with colorectal cancer for limited English proficient (LEP) patients compared with patients from an English background. Methods: All newly diagnosed patients from 2017 with colorectal cancer from a single health service with a highly multicultural catchment area and a well‐developed and integrated translation and language support (TALS) department were recruited. Time from referral to: biopsy, date seen by a surgeon, oncologist, discussion at a multidisciplinary meeting (MDM), and day of commencement of the first treatment modality, and overall survival were analyzed. Results: One hundred sixty‐two patients were analyzed, including 57 LEP patients from 22 countries of birth. Interpreters were present at 687/782 appointments with LEP patients. There were no differences in demographics or cancer staging. There were no differences between English background and LEP patients with regard to times from referral to biopsy (1 vs. 0 days), specialist review (surgical: 4 vs. 6 days, oncological: 45 vs. 57 days), MDM discussion (23 vs. 15 days), or commencement of treatment (32 vs. 28.5 days). There were no differences in treatment for colorectal cancer, although a higher rate of stomas was noted in LEP patients. There was no difference in overall survival between groups. Conclusion: Time to critical initial checkpoints and overall survival were similar in LEP and English background patients with colorectal cancer. An integrated TALS department may abrogate the language and cultural barriers that are known to disadvantage LEP patients and may contribute to normalizing care for the culturally and linguistically diverse community. [ABSTRACT FROM AUTHOR]

Background: Professional interpreters working in palliative contexts improve patient care. Whilst literature identifies psychological distress in other healthcare professionals, research into emotional effects on professional interpreters in this highly emotive setting is limited. Isolating emotional responses may enable targeted interventions to enhance interpreter use and improve wellbeing. Timely evidence is needed to urgently familiarise the profession with issues faced by these valuable colleagues, to affect practice. Aim: Describe the emotional effects on professional interpreters of interpreting adult palliative care conversations. Collate recommendations to mitigate negative emotional effects. Design: We performed a rapid review of studies identifying emotional effects on professional interpreters of interpreting adult palliative conversations. Rapid review chosen to present timely evidence to relevant stakeholders in a resource-efficient way. Thematic analysis managed using NVivo. Quality appraisal evaluated predominantly using CASP checklists. Reported using PRISMA guidelines. PROSPERO registration CRD42022301753. Data sources: Articles available in English on PubMed [1966–2021], MEDLINE [1946–2021], EMBASE [1974–2021], CINAHL [1981–2021] and PsycINFO [1806–2021] in December 2021. Results: Eleven articles from the USA (5), Australia (3), Canada (2) and UK (1). Eight interview-based, two online surveys and one quality improvement project. Themes included (1) Identifying diversity of emotional effects: emotions including stress, discomfort, loneliness. (2) Identifying factors affecting interpreters' emotional responses: impact of morals, culture and role expectations; working with patients and families; interpreter experience and age. (3) Recommendations to mitigate negative emotional effects: pre-briefing, debriefing and interpreter/provider training. Conclusion: Professional interpreters experience myriad emotional responses to palliative conversations. Role clarity, collaborative working and formal training may alleviate negative effects. [ABSTRACT FROM AUTHOR]

Background: Understanding disparities in pediatric kidney transplants is important to provide equitable care. We compared transplant outcomes between English-speaking (ES) and interpreter-needing (IN) pediatric kidney transplant recipients. Methods: Through retrospective review, primary kidney transplant recipients, 0–21 years transplanted between 2005 and 2019, were divided into ES and IN cohorts. Continuous and categorical variables were compared using Wilcoxon rank-sum, Welch two-sample t-test, and chi-squared analyses. Patient survival, graft survival, and rejection-free survival were evaluated using Kaplan–Meier methods and Cox regression. Days hospitalized were evaluated using negative binomial regression. Results: Our sample included 211 ES and 37 IN transplant recipients. Compared with the ES, the IN cohort was older at transplant (14.56 vs. 11.03 years; p < 0.01), had more time between kidney failure and transplant (0.9 vs. 0.3 years; p < 0.01), and more often received deceased over living donor transplants (78.4% vs. 30.4%; p < 0.01). Multivariate Cox proportional-hazard models evaluating adjusted 5-year patient survival demonstrated decreased 5-year post-transplant survival in the IN cohort (aHR = 10.10, 95% CI: 1.5, 66.8; p = 0.02). We did not identify differences in 5-year death-censored graft survival (aHR = 0.57; 95% CI: 0.14, 2.4; p = 0.4) nor rejection-free survival (aHR = 0.8; 95% CI: 0.4, 1.5; p = 0.5). We found significantly fewer hospitalization events in the IN cohort during the first year post-transplant (aRR: 0.62; 95% CI: 0.4, 0.9; p = 0.01) but no difference 5-year post-transplant. The IN cohort had more missed outpatient appointments (10.4% vs. 2.8%; p = 0.03) and undetectable serum immunosuppressant levels (mean: 3.8% vs. 1.3%; p = 0.02) 5 years post-transplant. Conclusions: Pediatric kidney transplant recipients requiring interpreter services for healthcare delivery demonstrate fewer post-transplant interactions with their healthcare team (fewer hospitalizations and more no-show visits) and lower 5-year patient survival compared with recipients not requiring interpreters. [ABSTRACT FROM AUTHOR]

Instability in the lives of young people in care is a public health concern. Placement moves and loss of relationships can have serious implications for young people's overall functioning, as well as their future life outcomes. Despite this, research often lacks the perspective and voice of young people in care. In this qualitative research, Interpretative Phenomenological Analysis was used to provide a deeper insight into young people's perceptions and beliefs about their care experiences to explore the impact of these on their ability to achieve a sense of stability and permanency across time. Semi-structured interviews were conducted with six males from UK foster, residential and semi-independent care homes. The main themes highlighted young people's perceptions of their care environment, relationships with others, sense of self and future under the overarching issue of permanence. Policy and practice implications propose strategies to target instability at the micro-level and how that may facilitate positive outcomes. The study revealed insights that may be helpful for frontline professionals and highlight to policy makers the importance of ensuring environmental and relational stability. An awareness of attachment theory to implement effective caregiving, should be a priority for training parents, caregivers, professionals and policy makers. [ABSTRACT FROM AUTHOR]

Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines. Based on extant literature on multicultural applications of neuropsychology, we provide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports. Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups. [ABSTRACT FROM AUTHOR]

Previous studies emphasise the negative psychological and physical consequences of Postnatal Depression (PND) on mothers and children's health. In the UK, around 10–20% of women can be affected by perinatal mental health problems. Minority ethnic groups such as Black African mothers are considered to be at greater risk of developing PND and data estimates that immigrant mothers are twice more likely to develop PND than native mothers. The unique experiences and needs of this culturally diverse group remain little explored in the UK. To address this gap in the literature, this study aimed to explore the lived experiences of First-Generation Nigerian Mothers (FGNMs) who suffered PND, their coping behaviours and treatment experiences in the UK. Six FGNMs with a previous diagnosis of PND and treatment experiences were purposefully recruited from GP practices and social groups attended by Nigerian mothers in the UK. Semi-structured interviews were analysed using Interpretative Phenomenological Analysis. Three master and seven subordinate themes were identified: (i) Socio-cultural factors (Inter-generational transmission; cultural perceptions: shame and stigma; transitions: adjusting to a new culture); (ii) What about me? The neglected nurturer (experiences of treatment; pretending to be OK); and (iii) Loneliness and coping (lack of support from partner; self-reliance). The study provides evidence about the difficulties encountered by FGNMs in relation to PND, including socio-cultural factors, neglect from family and healthcare professionals, and self-reliance as a coping strategy. Contrary to reports suggesting that Black ethnic groups do not seek help for their mental health needs, participants' accounts indicated that their attempts to engage with professionals were met with unsatisfactory responses. The findings highlight the need to address barriers affecting access to services by fostering a patient-centred and culturally sensitive approach in healthcare teams to effectively engage mothers at an early stage in the detection pathway. [ABSTRACT FROM AUTHOR]

Objective: It was aimed to compare self-care agency of refugee and native populations in chronic hemodialysis patients. Methods: The study was conducted with 33 refugees and 48 native patients in the hemodialysis unit of a training and research hospital in our country. Data were collected through face-to-face questionnaire. IBM SPSS statistics program was used to evaluate the data. Results: In the study, there was a significant difference between two populations in terms of drug use (p=0.041, p<0.05) and selfmonitoring (p=0.048, p<0.05), which were sub-dimensions of the self-care scale, but there was no significant difference between two populations in terms of the total self-care agency scores (p=0.768). It was determined that there was no significant correlation between the sub-dimensions of self-care agency and the year the refugees lived in our country and the months they underwent hemodialysis (p>0.05). Conclusion: It was observed that in chronic hemodialysis patients, the situation of meeting their self-care was the same in the refugee and native populations, while the refugees were insufficient in the use of drugs and the native population in self-monitoring. It is thought that it is necessary to get support from a hospital interpreter in order to eliminate language problems while giving self-care training to refugees, and it is thought that it will be appropriate to conduct the study with groups with different chronic diseases. [ABSTRACT FROM AUTHOR]

Objective: Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and interpreting administrators upon transitioning from on-site to remote work. Methods: From March through August 2021, we conducted focus groups with 22 sign language interpreters in 5 settings, 1 focus group for each setting: staff, educational, community/freelance, video remote interpreting, and video relay services. We also conducted 5 individual interviews with interpreting administrators or individuals in positions of administrative leadership in each represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) years, 18 were female, 17 were White, all identified as hearing, and all worked a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked participants about the positive and negative consequences of transitioning from on-site to remote at-home interpreting. We established a thematic framework by way of qualitative description for data analysis. Results: We found considerable overlap across positive and negative consequences identified by interpreters and interpreting administrators. Positive consequences of transitioning from on-site to remote-at-home interpreting were realized across 5 overarching topic areas: organizational support, new opportunities, well-being, connections/relationships, and scheduling. Negative consequences emerged across 4 overarching topic areas: technology, financial aspects, availability of the interpreter workforce, and concerns about the occupational health of interpreters. Conclusions: The positive and negative consequences shared by interpreters and interpreting administrators provide foundational knowledge upon which to create recommendations for the anticipated sustainment of some remote interpreting practice in a manner that protects and promotes occupational health. [ABSTRACT FROM AUTHOR]

As mixed methods research approaches become increasingly more common, it is imperative they are conducted in a thoughtful and rigorous manner to yield useful results. While researchers have begun to explore the use of various qualitative research methodologies in mixed methods research, there is a gap in literature discussing the philosophical congruence of using interpretive description in mixed method studies, and how to ensure rigor while integrating interpretive description results. Our purpose in writing this article is to discuss the issues of fit, purpose, process, context, and design when using interpretive description in mixed methods research approaches by drawing on examples from the literature. Further, we explore the contributions that interpretive description can make in a mixed methods inquiry. This article offers a first step in using a purposeful approach to mixed methods interpretive description studies to increase transparency and rigor in this relatively new methodology. [ABSTRACT FROM AUTHOR]

Background: The Communicate Study is a partnership project which aims to transform the culture of healthcare systems to achieve excellence in culturally safe care for First Nations people. It responds to the ongoing impact of colonisation which results in First Nations peoples experiencing adverse outcomes of hospitalisation in Australia's Northern Territory. In this setting, the majority of healthcare users are First Nations peoples, but the majority of healthcare providers are not. Our hypotheses are that strategies to ensure cultural safety can be effectively taught, systems can become culturally safe and that the provision of culturally safe healthcare in first languages will improve experiences and outcomes of hospitalisation. Methods: We will implement a multicomponent intervention at three hospitals over 4 years. The main intervention components are as follows: cultural safety training called 'Ask the Specialist Plus' which incorporates a locally developed, purpose-built podcast, developing a community of practice in cultural safety and improving access to and uptake of Aboriginal language interpreters. Intervention components are informed by the 'behaviour change wheel' and address a supply–demand model for interpreters. The philosophical underpinnings are critical race theory, Freirean pedagogy and cultural safety. There are co-primary qualitative and quantitative outcome measures: cultural safety, as experienced by First Nations peoples at participating hospitals, and proportion of admitted First Nations patients who self-discharge. Qualitative measures of patient and provider experience, and patient-provider interactions, will be examined through interviews and observational data. Quantitative outcomes (documentation of language, uptake of interpreters (booked and completed), proportion of admissions ending in self-discharge, unplanned readmission, hospital length of stay, costs and cost benefits of interpreter use) will be measured using time-series analysis. Continuous quality improvement will use data in a participatory way to motivate change. Programme evaluation will assess Reach, Effectiveness, Adoption, Implementation and Maintenance ('RE-AIM'). Discussion: The intervention components are innovative, sustainable and have been successfully piloted. Refinement and scale-up through this project have the potential to transform First Nations patients' experiences of care and health outcomes. Trial registration: Registered with ClinicalTrials.gov Protocol Record 2008644 [ABSTRACT FROM AUTHOR]