Bilingual Health Care Research Articles

Stakeholder preferences for implementation strategies to address barriers to depression treatment among Latino/a/x teens.

U.S. Latino/a/x adolescents experience inequities in depression treatment use in comparison to non-Latino/a/x White peers. The purpose of this study was to describe barriers to depression treatment use and implementation strategy preferences to address these barriers among Latinx teens. A qualitative descriptive study was conducted with Latino/a/x teens diagnosed with depression (n = 7), their parents (n = 7), and health care providers (n = 18) from across the United States. Qualitative content analysis was conducted to determine common barriers and preferences across groups. Family-level barriers included parents' knowledge and beliefs about depression treatment, parents' own stress, and generational gaps between parents and teens. Provider-level barriers were related to the lack of a bilingual and bicultural health care workforce, and health care system-level barriers included difficulties paying for and scheduling care, inadequate systems for follow-up, and policies limiting innovation and adolescent consent to treatment. Participants emphasized that family involvement was crucial and the importance of tailoring implementation strategies to meet the specific needs of individual Latino/a/x teens. Social support, psychoeducation about depression, and resource navigation support were preferred strategy components that should be facilitated by a bilingual Latinx individual with relevant lived experience and address cultural context. Multilevel implementation strategies will need to be developed to address the multilevel barriers to depression treatment use. Future research will further refine and test an implementation strategy package to determine the effect on the use of depression treatment among Latinx teens screening positive for depression in primary care settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Breastfeeding Basic Competence in Primary Care: A Spanish Translation and Cross-Cultural Validation of the CAPA Questionnaire.

The number of validated questionnaires that assess the level of breastfeeding competence of primary care professionals who attend lactating mothers is limited. To validate the CAPA (Competència en l'Atenció Primària sobre Alletament [Breastfeeding Competence in Primary Care]) questionnaire into Spanish in collaboration with professionals from the primary care services of the Comunidad de Madrid (Spain). In this multicentric study, four bilingual healthcare professionals translated the CAPA questionnaire into Spanish and back-translated it into Catalan. The cross-cultural adaptation included a discussion by an expert committee, a review by a philologist, and a pilot study that involved 13 healthcare residents. We randomly selected professionals from specialties involved in breastfeeding. The re-test was conducted 3 weeks later, aiming to avoid changes in the studied population. We performed a factor analysis to identify underlying constructs and hypothesis-testing to assess the validity of the questionnaire and estimated the Cronbach Alpha and intraclass correlation coefficient (ICC) to assess its reliability. A total of 198 professionals participated by responding to the questionnaire. Factorial analysis showed that the questionnaire was unidimensional. Hypothesis testing showed that, of all the considered professional groups, midwives achieved the highest mean score (M = 131.7, SD = 10.9, p < 0.001). Amongst the other professionals, only 26.5% achieved a basic level of breastfeeding competence. The Cronbach alpha and ICC were 0.852 (95% CI [0.821, 0.880]) and 0.890 (95% CI [0.800. 0.937]). The Spanish CAPA questionnaire is a valid and reliable tool for assessing breastfeeding basic competence among primary care professional groups who attend lactating mothers.

The Association of Patient-Provider Language Concordance with Healthcare Comprehension Among Mexican-origin Latino/as in Oregon

Objective: To understand the local Mexican-origin Latino community’s preference for bilingual health care providers and understand the relationship between language concordant care and comprehension of a healthcare visit. Background: Language barriers in healthcare negatively impact quality of care. Language concordant care (where a health care provider speaks the patient’s language) has been shown to result in better patient comprehension than using interpreters/translators. Study Design: This is a cross sectional study in collaboration with the General Consulate of Mexico. We developed a 20-item survey that includes questions about socio-demographics, an acculturation scale, and questions regarding language concordant care experience and preferences. Participants were aged 18 or older who had a healthcare visit within the past 12 months. We used descriptive and multivariable statistics to describe our sample and test the association of language concordant care and comprehension of the healthcare visit. Results We recruited 505 participants who all completed the survey in Spanish. Overall, 93.5% reported preference for a language concordant provider and 32.9% reported receipt of such care. Of those who reported a concordant provider visit, 87% reported a regular source of care compared to 50% among those with a discordant provider (p&lt;0.001). In multivariable analyses, patients with a concordant provider had higher odds of understanding everything their provider said (aOR = 10.53 (95% CI: 6.60-16.81). Conclusion There is a gap between the preference for language concordant providers and the receipt of this type of health care for Oregon Latinos. Increasing access to language concordant care can contribute to improving health care quality, equity, and outcomes for Latinos in Oregon.

Collateral positives of COVID-19 for culturally and linguistically diverse communities in Western Sydney, Australia.

To investigate whether culturally and linguistically diverse (CALD) communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were. A cross-sectional survey with ten language groups was conducted from 21st March to 9th July 2021 in Sydney, Australia. Participants were recruited through bilingual multicultural health staff and health care interpreter service staff and answered a question, 'In your life, have you experienced any positive effects from the COVID-19 pandemic?' Differences were explored by demographic variables. Free-text responses were thematically coded using the Content Analysis method. 707 people completed the survey, aged 18 to >70, 49% males and 51% females. Only 161 (23%) of those surveyed reported any positive impacts. There were significant differences in the proportion of those who reported positives based on age (p = 0.004), gender (p = 0.013), language (p = 0.003), health literacy (p = 0.014), English language proficiency (p = 0.003), education (p = <0.001) and whether participants had children less than 18 years at home (p = 0.001). Content Analysis of open-ended responses showed that, of those that did report positives, the top themes were 'Family time' (44%), 'Improved self-care' (31%) and, 'Greater connection with others' (17%). Few surveyed participants reported finding any positives stemming from the COVID-19 pandemic. This finding is in stark contrast to related research in Australia with participants whose native language is English in which many more people experienced positives. The needs of people from CALD backgrounds must inform future responses to community crises to facilitate an equitable effect of any collateral positives that may arise.

The Vision Detroit Project: Integrated Screening and Community Eye-Health Education Interventions Improve Eyecare Awareness

ABSTRACT Purpose Poor eye-health knowledge and health literacy are pervasive, contributing to worse outcomes. This study aims to examine short- and long-term eye-health knowledge retention following eye-health education interventions in adults. Methods Vision Detroit was an outreach vision screening program that integrated a 5-Point Teaching Intervention (5PTI), at a Southwest Community Center (SW-CC) from 2015–2017. The 5PTI consists of eye-health learning points developed to verbally educate patients. During vision screenings, eye-health knowledge tests were administered before and after 5PTI (Test 1 and Test 2, respectively). In 2016, Community Eye-Health Education Interventions (CHEI) were initiated at the SW-CC. During CHEI, bilingual healthcare students taught voluntary SW-CC members the 5PTI learning points, regardless of participant interest to attend future screenings. CHEI sessions occurred on separate dates prior to vision screening events. Test 1 and Test 2 scores were compared for all participants. Test 1 scores were compared for those who underwent CHEI prior to vision screening (CHEI positive) versus those who did not (CHEI negative). Results Two-hundred-seventeen adult patients met inclusion criteria, with 75.8% women, 82.6% Hispanic, mean age 50.4 ± 16.2 years, 74.6% had high school or less education, and 49.2% had health insurance. Test 1 to Test 2 scores improved after 5PTI (71.2 ± 26.4% vs. 97.2 ± 9.9%, p < .00001). Forty-eight participants attended CHEI and subsequent vision screening. Test 1 scores were higher among those CHEI positive versus CHEI negative (81.1 ± 2.1% vs. 68.3 ± 3.4%, p = .0027). Conclusion Simple eye-health education interventions, delivered during vision screenings and via community-based education, can improve eye-health knowledge.

Evaluation of Quality of Life of Adult Patients with Celiac Disease in Argentina: From Questionnaire Validation to Assessment.

This cross-sectional study aimed to translate, culturally adapt, validate, and apply a Celiac Disease Quality of Life (CD-QoL) questionnaire to a representative sample of Argentina’s celiac population. A previously developed and validated questionnaire (Celiac Disease Questionnaire: CDQ) was chosen as a tool for assessing the health-related quality of Life (HRQoL) of adult celiac patients in Argentina. Therefore, the study was performed in four stages: (a) translation and re-translation of the CDQ to Argentinian-Spanish language; (b) cultural adaptation and semantic evaluation; based on the Delphi method (c) validation of the CDQ by applying it to a representative sample of Argentinian celiac patients; (d) statistical analysis of the data. The result of stages (a) and (b) was a translated and culturally adapted an Argentinian-Spanish version of the CDQ, which was generated after reaching consensus between the corresponding four (phase a) and 10 (phase b) professionals involved in the different phases of this process. Among them, we can cite bilingual healthcare professionals with extensive experience in research and celiac disease, celiac patients, gastroenterologists, general practitioners, dieticians, and psychologists. The resulting CDQ proved to be an appropriate measuring tool to assess the HRQoL of Argentinian celiac patients confirmed by a good fit in the confirmatory factor validity analysis (RMSEA < 0.001 and χ2 = 267.325, df = 313, p = 0.971) and high values of internal consistency (Cronbach’s alpha > 0.7). A total of 191 participants accessed the questionnaire, and 171 individuals from 20 out of 23 Argentinian states completed the questionnaire. There was no correlation between higher educational level nor marital status with QoL. Individuals on a strict gluten-free diet (GFD) and those who do not take antidepressants showed higher QoL. Male gender also presented better HRQoL. There was no correlation between differences in HRQoL and age of the respondent, age at diagnosis, symptoms at diagnosis, or having other chronic diseases. However, a significantly higher score of HRQoL was reported among those individuals who disclosed having knowledge of CD related national regulations and benefits. This study highlights the importance of maintaining current public health regulations that support chronic disease patients, such as celiac patients.

When roles within interpreter-mediated psychiatric consultations speak louder than words.

In South Africa, clinicians working in public psychiatric hospitals are mainly fluent in English and Afrikaans, while the majority of patients are not proficient in these languages. Due to a lack of professional interpreting services, informal, ad hoc interpreters are commonly employed in public psychiatric hospitals. We collected data on language practices in public psychiatric care in South Africa, and provide a detailed account of what happens when bilingual health care workers and cleaners haphazardly take on the additional role of interpreter. Data were collected during 2010 at a public psychiatric hospital in the Western Cape, South Africa. Thirteen interpreter-mediated psychiatric consultations were video-recorded, and 18 audio-recorded semi-structured interviews were conducted with the interpreters and clinicians who participated in the interpreter-mediated psychiatric consultations. Patients were proficient in isiXhosa (one of the 11 official languages of South Africa), the clinicians (all registrars) were first language English or Afrikaans speakers, while the health care workers (nurses and social workers) and cleaners were fluent in both the patients' and clinician's language. Our findings suggest that interpreters took on the following four roles during the interpreter-mediated psychiatric consultations: regulating turn-taking, cultural broker, gatekeeper and advocate. Our findings suggest that, despite interpreters and clinicians having the patient's best interests at heart, it is the patient's voice that becomes lost while the clinician and interpreter negotiate the roles played by each party.

Challenges Faced by Bilingual Stroke Survivors in the Healthcare System: Unique Considerations

The experiences of multilingual patients communicating with unilingual healthcare providers have been largely unexplored. The aim of this study was to investigate the experiences of bilingual stroke patients within the Canadian healthcare context. A secondary analysis was completed with data from a multiple case study of the experiences of seven, low-income bilingual Francophone stroke survivors living in a predominately English area. Data included semi-structured interviews, chart reviews and language proficiency assessments. Results demonstrated that bilingual survivors experience unique challenges, including limited French health vocabulary, use of non-standard French, and generally low health literacy levels in both languages. Participants with aphasia often used English and French interchangeably, leading to the potential for miscommunication when providers were not bilingual. The study highlights the importance of having bilingual healthcare providers when bilingual stroke survivors have communication or cognitive limitations.

Translation and Validation of the HPLP-II From English to Armenian

As the focus of healthcare shifts toward the social determinants of health, more information about health disparities between different ethnic communities is needed. The Health Promoting Lifestyle Profile II (HPLP-II) is an instrument that measures health promotion behavior across various cultural lines. This article describes the translation and validation of the HPLP-II from English to Armenian for the purpose of studying health promotion behavior among the hypertensive and normotensive Armenian American population and addressing health disparities among this community. Translating the HPLP-II required a multistep process to capture cultural linguistic adjustment. First, the researcher, a local bilingual professor, and a professional translation company each created a forward-translation. These three translations were combined by an editor to create one translation with the highest clarity. The researcher then submitted this translation to two bilingual community members for back-translation. A committee composed of the researcher, the community members, and a bilingual healthcare worker reviewed each back-translated item and adjusted those that lost their meanings. Another committee reviewed each item for clarity and consistency. The instrument was then given to five native speakers who were asked to read each question and verbally express what they understood it to be asking. After the researcher made adjustments based on this feedback, the instrument was given to a committee of nine bilingual experts, who reviewed each item and scored it.This multistep, iterative process resulted in an instrument with an item content validity index score of 0.90 (&gt;0.78) and a scale content validity index of 0.96 (&gt;0.90), and Cronbach’s a = 0.936, suggesting a high level of reliability. The HPLP-II can now be used in future studies regarding health promotion behavior among Armenian Americans.

Perspectives of dementia from Asian communities living in New Zealand: A focus group of Asian health care professionals.

The number of Asian New Zealanders with dementia is growing. The objective of this study was to explore with a group of Asian health care professionals about public attitudes towards dementia in Asian communities in New Zealand, the stigma of dementia, and how best to develop culturally appropriate services for Asian people and families living with dementia. A focus group was conducted with a group of bilingual Asian health care professionals. A topic guide was developed based on the discussion at a prior meeting with the Cross Cultural Interest Group. The data were independently analysed by three researchers using the thematic qualitative methodology. Eleven overseas-born Asian health care professionals (Chinese: n = 9, 82%) participated in the focus group. Four main themes emerged from the data: (a) cultural interpretations of dementia; (b) stigma; (c) filial piety; and (d) inequity in the availability of resources. Our findings suggest that much work is needed to destigmatise dementia in New Zealand Asian communities, through psychoeducation, public awareness, and the availability of readily accessible services that can meet their cultural and language needs.

Nurses’ Perspectives on Language Standardization in Health Care

This article examines the ecology of language in an urban hospital in the U.S. Southwest. We seek to uncover how the incursion of the interpreting industry, and the ensuing language standardization that it has engendered, has affected the perception and use of Spanish among bilingual health care providers (HCPs), specifically nurses. Our findings show that the interpreting industry has not eliminated language exploitability (Alarcón &amp; Heyman, 2013; Alarcón &amp; Heyman, 2014) among bilingual HCPs but rather has made this exploitability more insidious. We argue that the interpreting industry has fomented a discourse of “risk” surrounding the use of Spanish in the hospital that affects bilingual HCPs’ perceptions of their own language skills by generating linguistic insecurities. We support our arguments by providing the results of a survey implemented to determine bilingual nurses’ use of certified medical interpreters (CMIs). These results are followed by excerpts from in-depth interviews conducted with bilingual nurses who participated in the aforementioned survey. Based on our findings, we determined that language the hospital’s language ecology classifies many bilingual nurses’ Spanish language skills as inadequate. We conclude by advocating for a more robust role for academic institutions in providing community education/trainings that recognize and advocate for the linguistic/cultural capital provided by bilingual HCPs.

Reducing infectious disease inequities among migrants.

migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.

The relationship between trust in primary care physicians and medication knowledge among diabetic patients.

Patients' trust in their physicians is critical to ensuring quality in healthcare. Despite the fact that both medication knowledge and trust in healthcare providers positively correlate with improved clinical outcomes, the presence of a link between these two attributes remains to be established. To determine whether a relationship exists between patients' trust in their primary care physicians and their medication knowledge. Patient trust was measured using the healthcare relationship (HCR) trust scale, and the medication knowledge by the self-reported medication knowledge questionnaire. Both forms were translated into Arabic by bilingual healthcare professionals. The relationship between the self-reported medication knowledge questionnaire scores and HCR-trust scale scores was determined by multiple linear regression, controlling for confounding variables. Based on information collected from 293 diabetic patients, a positive relationship was identified between patients' knowledge of medications and their trust in primary care physicians (β = 0.115; 95% confidence interval, 0.076-0.153; p < 0.0001). Medication knowledge was also positively associated with the female sex and education. A significant relationship exists between the patients' knowledge of their prescription medications and trust placed in their primary care physicians. The underlying mechanism of this association warrants further studies.

French translation and cross-cultural adaptation of the Michigan Hand Outcomes Questionnaire and the Brief Michigan Hand Outcomes Questionnaire

Patient-Reported Outcome Measures (PROMs) are important clinical devices for evaluating injuries and surgeries of the hand. However, some of the most widely used questionnaires, such as the MHQ and bMHQ, are currently unavailable in French, which prevents them from being used in the French Canadian province of Quebec as well as in other French-speaking nations. We therefore intend to develop valid and culturally adapted French translations of the afore-mentioned questionnaires. Two independent bilingual translators converted all English questionnaires to French. Two distinct translators then translated the French versions back to English in reverse-blinded fashion. Discrepancies between the original and second English versions were examined by a committee of four bilingual healthcare professionals before final French translations of all documents were produced. Thirty patients bilingual in French and English were then asked to complete the original and French versions of the MHQ and bMHQ. Their answers were compared in order to assess the accuracy of our translation. In light of these findings, revised French versions were produced. French versions of the MHQ and bMHQ questionnaires produced metrological qualities of validity and fidelity with an inter-class correlation superior to 0.90 and a kappa coefficient of 0.81 to 1. Clinical applicability revealed the distribution of scores according to disease process was reproducible between the English and French versions. PROM translation requires a rigorous process in order to achieve strong metrological qualities in both the original and translated versions. We produced French translations of the MHQ and bMHQ by abiding to the Beaton method of cross-cultural adaptation of self-reported measures.

Development of a Brazilian Portuguese adapted version of the Gap-Kalamazoo communication skills assessment form Development of a Brazilian Portuguese adapted version of the Gap-Kalamazoo communication skills assessment form

ObjectiveThe goal of this study was to translate, adapt and validate the items of the Gap-Kalamazoo Communication Skills Assessment Form for use in the Brazilian cultural setting. MethodsThe Gap-Kalamazoo Communication Skills Assessment Form was translated into Portuguese by two independent bilingual Brazilian translators and was reconciled by a third bilingual healthcare professional. The translated text was then assessed for content using a modified Delphi technique and adjusted as needed to assure content validity. A total of nine phrases in the completed tool were adjusted. The final tool was then used to assess videotaped simulations as a means of validation. Response process was assessed using exploratory factor analysis and internal structure was assessed via Cronbach’s Alpha (internal consistency) and Intraclass Correlation (test-retest reliability and inter-rater reliability). ResultsOne hundred and four (104) videotaped communication skills simulations were assessed by 38 subjects (6 staff physicians, 4 faculty physicians, 8 resident physicians, 4 professional actors with experience in simulation, and 16 other allied healthcare professionals). Measures of Internal consistency (Cronbach’s alpha = 0.818) and test-retest reliability (intra-class correlation coefficient = 0.942) were high. Exploratory factor analysis confirmed the uni-dimensionality of the instrument. ConclusionsOur results support the validity and reliability of the Brazilian Gap-Kalamazoo Communication Skills Assessment Form when used among Brazilian medical residents. The Brazilian version of Gap-Kalamazoo Communication Skills Assessment Form was found to be adequate both in the linguistic and technical aspects. The use of this instrument in Brazilian medical education can enhance the assessment of physician-patient-team relationships on an ongoing basis.

Repetition in the Health History Segment of Spanish Language Clinical Consultations: A Conversation Analysis.

Patient history-taking sequences may be repeated across medical speech events with different healthcare providers and subsequently co-constructed differently, which can lead to disparate patient history information with implications for patient care outcomes. Encounters that include language discordance between patients with limited English language proficiency and healthcare workers can also impact patient outcomes. We examined the repetition of patient history-taking sequences in consultations in which healthcare providers used Spanish as a first and second language with monolingual Spanish-speaking patients. The aim was to understand how repetition affects patient care processes and outcomes. Conversation analysis was used. The target population was bilingual healthcare providers and monolingual Spanish-speaking patients. The accessible population was composed of healthcare providers and patients from an urban, low-income, community health clinic in Southern California. In three exemplar cases from among 50 that were studied, instances of repetition in the history-taking segment of clinical consultations were located. We identified which aspects of patient reports were repeated across intake nurse-patient consultations and nurse practitioner-patient consultations, as well as how patient reports were differently co-constructed across these events. Information elicited during the intake nurse-patient history event may be elicited again when a nurse practitioner repeats the elicitation of particular aspects of the patient's complaints and health history. Repetition of patient history information was co-constructed differently by different healthcare providers, sometimes led to seamless teamwork, and sometimes led to time wasting. Healthcare provider second language use of Spanish did not substantially impact how patient history information was co-constructed. This analysis sheds light on the effects of repetition across medical events and assessed the effects of repetition on communication among members of a healthcare team and patient care outcomes. It also informs how medical provider second language use may affect how information is conveyed. Our study has implications for understandings of medical consultations that involve nurse triage prior to consultation time in multilingual settings.

Barriers to and facilitators of diabetes self-management with elderly Korean-American immigrants.

The aim of this study was to explore barriers to and facilitators of diabetes self-management among first-generation Korean-American elderly immigrants with type 2 diabetes in the United States Midwest. The number of Korean-American elderly immigrants with type 2 diabetes in the United States is expected to increase because they are at risk of adopting a Western lifestyle. Three focus groups (N=18) and five individual interviews were conducted with Korean-American elderly immigrants with type 2 diabetes. Demographic characteristics and diabetes-related medical history information were obtained with a questionnaire. All data were digitally recorded, transcribed verbatim and translated from Korean into English. Transcripts were analysed using standard content-based analysis. Five perceived barriers were identified: the high cost of type 2 diabetes care, language issues, loss of self-control, memory loss and limited access to healthcare resources. Three perceived facilitators were time, seeking information, and family and peer supports. The convenience samples and small sample size may limit the study. The barriers to and facilitators of diabetes self-management identified in this study can be used in the development of more age- and culturally sensitive diabetes interventions and resources. Nurses and healthcare providers can use this study's findings to develop patient-centred, age-appropriate and culturally appropriate diabetes interventions. There are urgent needs to train bilingual healthcare providers and staff and to provide translation services for Korean-American elderly immigrants. Finally, communities and social supports within public health policy are urgently needed for this ethnic minority group.

Inherent Tensions and Challenges of Oncologist–Patient Communication: Implications for Interpreter Training in Health-care Settings

By examining actual medical encounters, we identify specific communicative characteristics inherent in gynecologic oncologist–patient interactions in the USA that may lead to challenges and barriers to successful bilingual health care. By using monolingual medical encounters, we aim to address the research design challenges in the field of bilingual health care and to generate new approaches to the research and training of health-care interpreting. In total, 44 segments (553.25 minutes) of the first medical visits to a gynecologic oncology clinic were included in the study. Using discourse analysis and a grounded hermeneutic approach, we found that oncologist–patient communication poses challenges for interpreters' management of medical encounters in the following ways: (1) speakers' inconsistent, ambiguous talk, (2) incompatible sociolinguistic norms, and (3) providers' multilayered identity performances. Our findings highlight the importance of educating interpreters to be not only responsive but also proactive in managing the various intended and unintended meanings emerged in the discursive process.

Not just "getting by": factors influencing providers' choice of interpreters.

Providers consistently underutilize professional interpreters in healthcare settings even when they perceive benefits to using professional interpreters and when professional interpreters are readily available. Little is known about providers' decision-making processes that shape their use of interpreters. To understand the variety of considerations and parameters that influence providers' decisions regarding interpreters. A qualitative, semi-structured interview guide was used to explore providers' decision making about interpreter use. The author conducted 8 specialty-specific focus groups and 14 individual interviews, each lasting 60-90 minutes. Thirty-nine healthcare professionals were recruited from five specialties (i.e., nursing, mental health, emergency medicine, oncology, and obstetrics-gynecology) in a large academic medical center characterized as having "excellent" interpreter services. Audio-recorded interviews and focus groups were transcribed and analyzed using grounded theory to develop a theoretical framework for providers' decision-making processes. Four factors influence providers' choice of interpreters: (a) time constraints, (b) alliances of care, (c) therapeutic objectives, and (d) organizational-level considerations. The findings highlight (a) providers' calculated use of interpreters and interpreting modalities, (b) the complexity of the functions and impacts of time in providers' decision-making process, and (c) the importance of organizational structures and support for appropriate and effective interpreter utilization. Providers actively engage in calculated use of professional interpreters, employing specific factors in their decision-making processes. Providers' understanding of time is complex and multidimensional, including concerns about disruptions to their schedules, overburdening others' workloads, and clinical urgency of patient condition, among others. When providers make specific choices due to time pressure, they are influenced by interpersonal, organizational, therapeutic, and ethical considerations. Organizational resources and guidelines need to be consistent with institutional policies and professional norms; otherwise, providers risk making flawed assessments about the effective and appropriate use of interpreters in bilingual health care.

Effectiveness of culturally tailored diabetes interventions for Asian immigrants to the United States: a systematic review.

The purpose of this systematic review is to evaluate the effectiveness of tailoring community-based diabetes intervention to Asian immigrant cultures. The Cochrane processes and Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations guided this systematic review. PubMed, the Cumulative Index to Nursing and Allied Health Literature, Ovid, and PsycINFO were searched for analyses and syntheses of primary research published since 2000 that described interventions tailored for the cultures of Asian immigrants with diabetes. This search yielded a total of 9 articles published from 2005 to 2013. The Amsterdam-Maastricht Consensus List for Quality Assessment was used to assess the quality of the studies. Retrieved studies' populations were foreign-born adults >50 years of age with type 2 diabetes. The review revealed that culturally tailored diabetes programs are effective at improving patients' objectively measured clinical outcomes, in particular A1C levels, and psychobehavioral outcomes. Patients were also highly satisfied with bilingual health care providers and bilingual educational programs. There is strong evidence of the effectiveness of tailoring diabetes interventions to Asian immigrant populations' cultures. Further studies, including longitudinal studies and studies with rigorous research designs that subclassify Asian immigrants, are needed to encourage the implementation of culturally tailored diabetes intervention for this ethnic minority.