A Systematic Review of Interventions to Address Accent-Related Communication Problems in Healthcare.

Yulong Gu,Amee P Shah

doi:10.31486/toj.19.0028

Abstract

Background: Linguistic diversity in terms of speech, accent, and dialect can present a barrier to communication in healthcare. This review synthesizes current evidence on the effectiveness of interventions that target accent- or dialect-related communication problems in healthcare.Methods: Eligible studies were identified through a search of literature databases in 2018 using medical subject heading (MeSH) terms and additional keywords. Articles were screened for eligibility according to predetermined inclusion criteria. Because of the heterogeneity of the studies, effect data were analyzed using narrative synthesis.Results: Twenty-six studies (n=964) were included, reporting a range of interventions that provided accent modification training, role play or simulated patient consultation training, general language and consultation skills training, web-based training, and cultural competence training. Most studies (24 of the 26) indicated some benefits of the accent elements in the interventions based on objective or subjective measures. The key benefits were improvements in speech production, communication competence, and academic/clinical performance, as well as perceptual changes.Conclusion: Notwithstanding the low research quality and lack of standardized measures in the included studies, this review establishes an evidence base for implementing accent-related communication improvement strategies in healthcare. Large randomized controlled studies would be helpful to strengthen this evidence base.

Highlights

The quality of communication in healthcare has a significant impact on patient-clinician relationships and patient satisfaction,[1] patient safety,[2] health outcomes,[3] care team collaboration,[4] and professional liability.[5]
Characteristics of Accent Interventions The studies included in this review described several accent intervention strategies: r Accent reduction training, often led by a speech-language pathologist (SLP)[21,22,33,34,35,36,37,38] r Role play or simulated patient consultation training[7,39,40,41,42,43,44,45,46,47,48] r General language and consultation skill training[49,50,51,52]
Despite the lack of standardized outcome measures in the studies included in this review, the current evidence suggests that accent interventions in the healthcare context can have direct benefits on communication quality: improvement in speech production, clarity, intelligibility, listening comprehension, knowledge of colloquialism and phonological rules, and reduction of phonological errors

Summary

Introduction

The quality of communication in healthcare has a significant impact on patient-clinician relationships and patient satisfaction,[1] patient safety,[2] health outcomes,[3] care team collaboration,[4] and professional liability.[5]. The United States is the largest importer of nurses, with approximately 219,000 registered nurses who were trained overseas.[6] More than one-third of the United Kingdom National Health Service medical workforce was trained overseas,[7] and onethird of the doctors working in Australia were trained overseas.[8] In addition, the growing cultural heterogeneity in patient populations resulting from immigration has been noted in the United States and Europe.[9,10] The globalization of the healthcare workforce and patient populations presents a challenge for both clinician-patient communication and clinician-clinician communication Part of this challenge is to achieve speech clarity and comprehension when speakers with different accents or dialects participate in a verbal conversation. Large randomized controlled studies would be helpful to strengthen this evidence base

Methods

Results

Discussion

Conclusion