Ethnic Language Research Articles

Abstract 4136799: Disparities in Diagnosis and Treatment of Heterozygous Familial Hypercholesterolemia

Introduction: The prevalence of heterozygous familial hypercholesterolemia (HeFH) is 1:250. Untreated individuals have up to a 20-fold increased risk for premature coronary artery disease (CAD). In adults, low socioeconomic status (SES) individuals, bear a disproportionate share of the CAD burden. In this context, we sought to examine the association of social determinants of health and age at HeFH diagnosis and treatment. Methods: We performed a retrospective single-center study of children with HeFH who presented to the Lipid Heart Clinic at the Children’s Hospital of Philadelphia (2012-2022). The primary outcome was age at HeFH diagnosis. The secondary outcome was age at statin initiation. Multivariable linear regression models were used to examine the association between the primary exposure of interest, Child Opportunity Index (COI) and the outcomes. Secondary exposures included race, ethnicity, health insurance, and primary language. To explore potential referral bias, we compared the COI of the study cohort to that of the institution’s catchment area, defined as within a two-hour drive of the primary clinic. Results: We evaluated 577 patients. The median age at presentation was 12 (9, 14) years and the median LDL-C was 199 (169, 235) mg/dL; 58% were prescribed a statin with a median age of statin initiation of 13 (10, 15) years. The median COI for the cohort was 84 (62, 95). There was no association between COI, ethnicity, health insurance, or primary language and the age at HeFH diagnosis or statin initiation. On multivariable analysis, black race was associated with older age at HeFH diagnosis compared to white race (adjusted estimate 1.2 +/- 0.49 yrs, p = 0.014). There was no difference in age at statin initiation by race. Higher LDL-C, male sex, and lower BMI percentile were associated with younger age at statin initiation. The COI distribution of the study cohort was significantly different than that of the catchment area (p < 0.001). 70% of the study cohort were of high and very high COI compared to 57% of the catchment area. Conclusion: Black race was associated with older age at HeFH diagnosis, however, there were no disparities in age at statin initiation. The COI of the cohort was significantly higher than that of the catchment area suggesting that low COI populations are under-referred for HeFH evaluation. Future efforts should focus on improving barriers to universal screening and identifying obstacles to HeFH diagnosis and referrals.

Language Dominance in the Input and Use Patterns of Cameroon’s Special Bilingual Students

This paper examines dominance in the language input and use patterns of students of Cameroon’s Special Bilingual Education Programme (SBEP). The participants were 373 bilingual students from 10 schools set in French-speaking Cameroon, who submitted self-ratings via an adapted version of the Bilingual Language Profile questionnaire by Birdsong, Gertken and Amengual (2012). The data were analysed using the subtraction method to determine dominance. The results showed a consistent pattern of OL1-dominance for all the three domains considered under language input (viz. listening, reading, and watch time), but a more contrasted pattern for language use, as the respondents were found to be French-dominant (or slightly OL1-dominant to balanced) in the outer circle of relationships (circle of friends and school environment) and OL1-dominant in the inner circle (self-talk and family circle). The findings of this study suggest that individual language use is more significantly impacted by societal dominance than language input is, most likely because the latter is less constrained by relationships and offers a greater possibility of choice. They equally suggest that there is a directionality in the influence of societal dominance, with a decreasing effect from the public to the private sphere. Lastly, the study underscores the powerful negative impact the lack of official recognition can have on the maintenance of local ethnic languages in a multilingual context.

Disparities in Patient Portal Activation and Usage at a Large Pediatric Academic Institution.

Access to personal medical information promotes patient understanding of health issues and enables patient self-advocacy of healthcare needs. The advent of electronic medical record systems and the 2016 21st Century CURES Act promoted and encouraged patient access to personal medical information, yet technology-dependent modalities have often disadvantaged certain communities. We sought to evaluate whether disparities existed in access to patient portals at our institution, the main pediatric care provider in an area serving one million children. We evaluated the activation of patient portal accounts at our institution over the past decade (2010-2021). Portal activation data were analyzed by ethnic background and language preference and income information available based on primary home access location. Further, we evaluated portal activation rates over time and across institutional interventions. A logistic regression model was used to identify important demographic associations with portal account status. Over 1 million patients were served at our pediatric institution over the study period with 47.7% having ever activated their patient portals. Univariate analyses and ultimately logistic regression modeling demonstrated significant differences in portal activation by ethnicity (odds ratio (confidence interval):1.36 (1.34, 1.37)), language preference (1.39 (1.37, 1.40)), and median household income (1.00001 (1.00001, 1.00001)). Interim interventions were successful in improving portal activation rates. Overall, electronic medical record portal activation was less prevalent among Hispanic, non-English speakers, and patients living in communities with lower median household income. Opportunities for interventions exist to reduce healthcare disparities in these underserved communities.

Patterns of patient-reported outcomes (PROs) in a diverse group of gynecologic cancer survivors

ObjectivesRacial and ethnic disparities in patient-reported outcomes (PROs) among gynecologic cancer survivors are not well studied. We evaluated whether individual-level characteristics were associated with PROs in diverse gynecologic cancer survivors.MethodsGynecologic cancer patients in an ambulatory oncology clinic completed a psychosocial and practical needs assessment before their appointments through the electronic medical record (EMR) patient portal. Assessments were available in English and Spanish. Fatigue, pain, physical function, depression, and anxiety were assessed with Patient-Reported Outcomes Measurement Information System (PROMIS®) computer adaptive tests, and health-related quality of life was assessed by FACT-G7. PROs were dichotomized based on severity (normal/mild vs moderate/severe). Demographic and clinical information was collected. Analyses were performed using Chi-square, t-tests, and Kruskal–Wallis tests.ResultsA total of 582 women completed the assessment; 20% (n = 116) were racial minorities, and 54.5% (n = 310) were Hispanic. A total of 192 (32.8%) completed the assessments in Spanish. Hispanic patients had lower mean fatigue scores (49.31 vs 51.74, p = 0.01), and patients whose preferred language was Spanish had lower mean depression (47.63 vs 48.97, p = 0.05) and fatigue scores (48.27 vs 51.27, p < 0.01). There were no significant differences in the severity of PROs by race, ethnicity, or preferred language. QOL scores were worse in patients with high symptom severity for anxiety (p = 0.04) and physical functioning (p < 0.01). Current smokers had worse physical functioning (13.4% vs 6.5%, p = 0.03).ConclusionsWe found no significant differences in severity of PROs by race, ethnicity, or preferred language. Quality of life scores were worse for patients with high symptom severity for physical functioning and anxiety.

Bhinneka Tunggal Ika: Real Proof Of The Power Of Pancasila

Indonesia is a nation rich in diversity, encompassing a variety of ethnic groups, religions, languages, and cultures. The concept of Bhinneka Tunggal Ika—"Unity in Diversity"—reflects this pluralism, advocating for peaceful coexistence despite differences, embodying the essence of Pancasila, the foundational ideology of the country. The national motto, symbolized by the Garuda Pancasila emblem, signifies the unity of the Indonesian people. This study aims to demonstrate that the challenges facing Indonesia's adherence to Pancasila can be addressed through the application of Bhinneka Tunggal Ika. Using qualitative research methods, particularly library research, data were collected from various sources including books, academic journals, and recent studies. The results emphasize that Bhinneka Tunggal Ika has long been a cornerstone of national unity and a symbol of Indonesia's rich diversity. Implementing Pancasila’s values in alignment with this motto fosters national welfare and underscores the importance of tolerance and interfaith harmony. Additionally, Bhinneka Tunggal Ika plays a vital role in raising awareness of nationalism and reinforcing societal cohesion.

Kimbu speakers’ attitudes toward language endangerment

This article is based on a study that assesses the attitudes towards language endangerment of Kimbu speakers, a minority language spoken in the Chunya and Sikonge Districts in Tanzania. The study used a descriptive approach to assess whether Kimbu speakers have developed negative attitudes towards their language, have ambivalent language loyalty and are indifferent about language transfer to children. Data for this study were collected through interviews with 50 Kimbu speakers. The study revealed that most of the Kimbu parents and younger generation are ambivalent and indifferent about their language, and they have developed negative attitudes towards it, claiming that it has no socio-economic and educational significance. Because of such a situation, they have ceased using it in most genuine and natural domains like home and other social functions in favour of other co-existing languages. The study concludes that the Kimbu language is relatively unsafe from endangerment. The recommendation is made that Kimbu speakers should be told of the importance of ethnic community languages and that they make a symbolic identity, therefore teaching their children the language and encouraging the use of it everywhere in the community will pave the way to positive attitudes, and ensure language vitality.

Maintaining ethnic identity and heritage language through community involvement: a case study of third-generation Australian-Latvians

ABSTRACT By the third generation, migrant languages are usually no longer spoken and few identify with their grandparents’ ancestry. This study investigates factors that have encouraged a group of third-generation Australian-Latvians in their teens and twenties to maintain their ethnic identity and heritage language. Active community involvement was found to be a major factor, particularly in organizations such as Latvian schools, folk dancing, and singing groups. Involvement is facilitated by their connections with family, friends, people, and organizations in Latvia, and creates an individual sense of belonging with the community and identification as a Latvian.

ETHNOGRAPHISMS IN THE NOVEL “ELEN-ALAN”

In the modern era of developed globalization, the main driving force for the formation of a nation, integration as a people, unification as a country, preservation of national traditions is our ethnic mentality, language, religion and actual thinking. The main idea of the study is to cite ethnographic data from the historical novel “Elen-Alan”, which reflects the history, traditions and thoughts of our nation, using local color phraseology, proverbs and sayings in the language of the writer. The article aims to identify the content of individual phrases and phrases that determine the language skills of the writer by conducting an ethnolinguistic study of Ethnography in the language of A. Kekilbayev. The relevance of the study is manifested in the justification within the framework of linguistic ethnographisms that the ethnocultural unity of the writer's language forms a fund of ethnolexic words. The novelty and value of the topic of the article is emphasized by the fact that the study of phrasal phrases and parables related to domestic customs, traditions and customs that reflect the national character in the language of the writer is taken and evaluated in a holistic context. In the course of the study, methods of systematization and description of language material were used. The need to collect ethnographisms in the writer's language and create a systematic dictionary as future perspectives of the research was determined.

Automatic Enrollment in Patient Portal Systems Mitigates the Digital Divide in Healthcare: An Interrupted Time Series Analysis of an Autoenrollment Workflow Intervention

PurposeRacial and ethnic healthcare disparities require innovative solutions. Patient portals enable online access to health records and clinician communication and are associated with improved health outcomes. Nevertheless, a digital divide in access to such portals persist, especially among people of minoritized race and non-English-speakers. This study assesses the impact of automatic enrollment (autoenrollment) on patient portal activation rates among adult patients at the University of California, San Francisco (UCSF), with a focus on disparities by race, ethnicity, and primary language.Materials and methodsStarting March 2020, autoenrollment offers for patient portals were sent to UCSF adult patients aged 18 or older via text message. Analysis considered patient portal activation before and after the intervention, examining variations by race, ethnicity, and primary language. Descriptive statistics and an interrupted time series analysis were used to assess the intervention’s impact.ResultsAutoenrollment increased patient portal activation rates among all adult patients and patients of minoritized races saw greater increases in activation rates than White patients. While initially not statistically significant, by the end of the surveillance period, we observed statistically significant increases in activation rates in Latinx (3.5-fold, p = < 0.001), Black (3.2-fold, p = 0.003), and Asian (3.1-fold, p = 0.002) patient populations when compared with White patients. Increased activation rates over time in patients with a preferred language other than English (13-fold) were also statistically significant (p = < 0.001) when compared with the increase in English preferred language patients.ConclusionAn organization-based workflow intervention that provided autoenrollment in patient portals via text message was associated with statistically significant mitigation of racial, ethnic, and language-based disparities in patient portal activation rates. Although promising, the autoenrollment intervention did not eliminate disparities in portal enrollment. More work must be done to close the digital divide in access to healthcare technology.

Linguistic landscape in George Town, Malaysia: Language visibility in a postcolonial and globalized context

The visibility of languages in the linguistic landscape reflects various aspects of linguistic diversity and dynamics in a given territory, signifying social interactions, identities, and power relationships among ethnic groups. However, postcolonial acontexts with widespread use of ethnic minority languages and the coexistence of state-sponsored national languages with precolonial official languages in the era of globalization have received limited research. This paper investigates the visibility of language in three neighbourhoods in George Town, Malaysia, a former administrative city under British governance, focusing on language visibility within three distinct neighborhoods: Chinatown, Little India, and the Beach Street. The study reveals a complex interplay of languages, highlighting the predominance of English as an information carrier and a symbol of modernity, alongside the increasing prominence of Chinese and the lesser visibility of Tamil and underrepresentation of other minority languages. The research underscores the ethnic boundaries between the vibrant enclaves of Little India and Chinatown, while Beach Street serves as a multicultural space reflecting a blend of local and global influences.

THE SOCIOLINGUISTIC POSITION OF PALEMBANG RELIGIOUS POETRY

This article examines the sociolinguistic position of Palembang religious poetry in the Palembang speech community in South Sumatra, Indonesia. The Palembang language is unique in that it is used as a language of wider communication and listed as level 3 on EGIDS, yet it does not have an official writing system. Until this study, no academic research on Palembang religious poetry had ever been conducted. This research examines the use of Palembang religious poetry by Palembang people. Ethnographic research methods were employed, and poets and poetry users from various backgrounds and ages were interviewed. Palembang traditional poetry called pantun is also discussed. Findings reveal the origins and the types of religious poetry. Research highlights five poems: three autogenic poems and two translated poems. Three poems are considered spoken poetry and two poems are sung. Poets and poetry users of Palembang religious poetry in this research consist of four men and three women ranging from 25-65 years of age. There are examples of Palembang religious poetry undergoing language shift but it is clear that poetry has strong connections to ethnic identity and language pride.

Embracing the Jewess: Reading Gender and Ethnicity in Judith with the Belle Juive

Abstract In this article, I explore the intersections of gender and ethnic categories in the book of Judith. The entire book—titled after a character whose name means “Jewess”—is suffused with commentary on both Judith’s womanhood and her Jewish identity. Here, I focus on chapters 10, 11, 12, and 14 of the book, which contain the language of both gender and ethnicity. Judith’s Jewish identity is discussed in the same breath as her gender and beauty, presenting an opportunity to examine how the categories of womanhood and Jewishness are invoked and how they complicate one another. This article will use the figure of the belle Juive, or “beautiful Jewess,” to discuss how gender and Jewishness interact in Judith. I will discuss how the conversations between Judith and the Assyrians play with assumptions the Assyrians have about women and Jews, and how meeting Judith shapes the Assyrians’ ideas about the rest of her people. We can read this encounter as engineered by the character of Judith, with attention to the complicated dynamics of gender and national identity, to produce exactly the result she gets: an Assyrian army and general that unwittingly hands her the power to achieve her goal.

The Impact of Ethnic Identity on Language Attitudes

ABSTRACT Few studies have explored the relationship between ethnic identity and language attitudes in heritage language speakers. Via self-reported questionnaire data, the present study examined correlational and causal connections between ethnic identity and language attitudes in three generations of Israeli and American Mountain Jews. Native to the eastern Caucasus, Mountain Jews immigrated in the 1990s to Israel and the United States, bringing with them two heritage languages, Juhuri and Russian. The effect of ethnic identity on language attitudes emerged as strong for both Juhuri and Russian, but varied across countries, generations, languages, and types of attitudes. Strong correlations between ethnic identity and language attitudes were found for both heritage languages in Israel, but in the United States the connection between Russian and Mountain Jewish identity was lost across generations. Results are discussed in terms of previous research on heritage languages, identity and attitudes, and highlight the revival of ethnic identity among second-generation immigrants.

I’m Still Nigerian: Navigating Race Through Digital Literacies

Literacy scholarship captures immigrant youth of color ethnoracial identity constructions through their digital literacy practices. Still, few studies examine how immigrant youth of African origin use digital literacy to navigate ethnoracial tensions and craft racialized identities. Drawing on raciolinguistic and postcolonial theory, this study extends and nuances existing scholarship by examining the digital literacy practices and ethnoracial identity formations of a 13-year-old Nigerian girl who migrated to the United States. Positioning my analysis within the intersection of race, language, and identity, I inquire: How does Isioma leverage digital literacies to navigate U.S. racialization and negotiate U.S. racial identity categories? Furthermore, how does Isioma employ digital literacies to construct and negotiate her ethnoracial identities? I employ a narrative analysis of home observations, semistructured interviews, and literacy artifacts. Findings illustrate how digital tools disrupt raciolinguistic perspectives against minoritized languages. Digital literacies also enable the preservation of ethnic identities and languages while influencing racialized and hybrid identity formation and narration in the physical world.

Ethnic integration and evolution of the phonological features of Northern Standard Chinese Language

ABSTRACT: Ethnic integration is often accompanied by language contact and language shift. The process of "ethnic integration" is the process of "remolding" northern standard Chinese language into an inter-ethnic language and ultimately into a common national language. Only by reevaluating the phonological rules and structure of the languages (mainly Altaic) of northern non-Han ethnic groups and investigating the interference with and influence on Chinese during the language shift by the non-Han ethnic groups, can we comprehend that the common national language is a language community jointly shaped by the Han people and other ethnic groups during ethnic integration. The speakers of ethnic languages are, therefore, not only the transmitters but also the co-modelers in forming the common national language. 摘要: 民族融合往往伴随着语言接触和语言转换。"民族融合"的过程就是 将北方标准汉语"重塑"为族际共同语进而成为民族共同语的过程。 只有基于以阿尔泰语为主的北方诸民族语音系规则和音韵结构特征重 新思考并深入研究以阿尔泰为主的北方诸民族在转用汉语过程中对汉 语形成的干扰和影响，才能理解民族共同语是在民族融合过程中汉族 与其他民族共同塑造的语言共同体。在民族共同语形成的过程中，民 族语者不仅是民族共同语的传播者，也是民族共同语的共同塑造者。

Disparities in Delirium across the Continuum of Care and Associations with Social Determinants of Health.

Disparities exist in the identification, treatment, and management of delirium. These disparities can be most holistically and comprehensively understood by using a social-ecological model-which acknowledges multilevel impacts including individual, interpersonal, organizational, community, and policy-level factors-as well as a social determinant of health framework, that considers nonmedical factors that influence health outcomes. This narrative review leverages both frameworks to identify and discuss existing literature pertaining to the intersection of these social risk factors and delirium, focusing specifically on disparities due to racial and/or ethnic identity, language ability, and socioeconomic differences. We also look at disparities and the potential role of these social risk factors throughout the continuum of care, including prehospitalization, hospitalization, and posthospitalization factors. Understanding and analyzing the role of these inequities is critical to ensuring better health outcomes for patients at risk of and/or with delirium.

The Effects of Sheng’ Vocabulary Usage in the Learning of Kiswahili Grammar in Public Secondary Schools in Kenya

Purpose: Sheng’ is a linguistic code based primarily on the Kiswahili structure and grammar with the lexicon drawn from Kiswahili, English and the various ethnic languages of Kenya; that are mostly spoken in towns and other urban areas. The purpose of this paper was to examine the effects of Sheng’ vocabulary on the learning of Kiswahili grammar in public secondary schools in Kenya. Methodology: Krejcie &amp; Morgan sampling table was used to sample the schools. Stratified random sampling, simple random sampling and purposive strategy were used to sample the public secondary schools to participate. Krejcie and Morgan sampling table was used to sample 55 teachers of Kiswahili and 360 students to take part in the study. Data was collected using observation schedules, focused group discussion guides and a writing task for students. Questionnaires and interview guides were used for teachers of Kiswahili. Qualitative data collected was analyzed thematically to generate information that was summarized in graphics and discussed in narrative form. Quantitative data was analyzed with the help of Statistical package for social Studies. Findings: The findings of the study further revealed that Sheng’ vocabulary influenced written Kiswahili grammar as learners wrote Sheng’ words whereas they were expected to write standard Kiswahili. Unique Contribution to Theory, Policy, and Practice: School administrators should come up with a school-based language policy so as to control learners’ language environment. The ministry of education should encourage the culture of drama, music and debate competition among schools. The Kenya Institute of Curriculum Development should also ensure language use is stipulated in Kiswahili curriculum and Sheng’ be considered as an independent language code in the country.

Impact of Demographics on Regional Visual Field Loss and Deterioration in Glaucoma.

To elucidate the impact of demographics, including gender, race, ethnicity, and preferred language, on regional visual field (VF) loss and progression in glaucoma. Multivariable linear mixed regressions were performed to determine the impact of race, ethnicity, and preferred language on regional VF loss with adjustment for age and gender. Regional VF loss was defined by pointwise total deviation values and VF loss patterns quantified by an unsupervised machine learning method termed archetypal analysis. All cross-sectional and longitudinal analyses were performed both without and with adjustment for VF mean deviation, which represented overall VF loss severity. P values were corrected for multiple comparisons. All results mentioned had corrected P values less than 0.05. Asian and Black patients showed worse pointwise VF loss than White patients with superior hemifield more affected. Patients with a preferred language other than English demonstrated worse pointwise VF loss than patients with English as their preferred language. Longitudinal analyses revealed Black patients showed worse VF loss/year compared to White patients. Patients with a preferred language other than English demonstrated worse VF loss/year compared to patients preferring English. Blacks and non-English speakers have more severe VF loss, with superior hemifield being more affected and faster VF worsening. This study furthered our understanding of racial, ethnic, and socioeconomic disparities in glaucoma outcomes. Understanding the VF loss burden in different racial, ethnic, and socioeconomic groups may guide more effective glaucoma screening and community outreach efforts. This research could help reduce vision loss and improve quality of life in disproportionately affected populations by guiding public health efforts to promote glaucoma awareness and access to care.

Racial, Ethnic, and Language Inequities in Ambulatory Pediatrics Patient Family Experience

ObjectiveTo determine the association of patient race, patient-provider racial congruence, patient ethnicity, and family primary language with patient family experience (PFE) survey responses. MethodsCross-sectional review of PFE survey responses from all ambulatory medical encounters at a large, urban children’s hospital system June 1, 2020—May 31, 2022. Exposures were patient race, patient-provider racial congruence, patient ethnicity, and family primary language. We adjusted analyses for neighborhood-level socioeconomic deprivation, patient sex and age, encounter specialty, and location of care. Outcomes were PFE survey scores for five questions focused on overall experience, respect, and safety; categorized using industry standard metric of presence of a “top-box” score, defined as a nine or 10 for questions on an 11-point scale or as four on a four-point scale. ResultsWe included 89,175 surveys (15.6% response rate). The odds of having optimal, “top-box” responses for several assessed questions were lower for patients identified as Asian (eg, adjusted odds ratio [OR] 0.46; 95% confidence interval [CI] 0.40, 0.52) or Black (eg, OR 0.65; CI 0.60, 0.70) compared to White, and for Hispanic (eg, OR 0.84; CI 0.72, 0.97) compared to non-Hispanic. Similarly, the odds of having “top-box” scores were lower for Spanish-primary-language (eg, OR 0.38; CI 0.30, 0.48) compared to English-primary-language patients. Patient-provider racial congruence had higher odds of “top-box” responses for two of five assessed questions (eg, OR 1.18; CI 1.04, 1.35). ConclusionsWe found previously unreported inequities in ambulatory pediatric PFE outcomes, with worse experiences reported by Asian, Black, Hispanic, and Spanish-language patients.

Sociodemographic Differences in Perspectives on Postpartum Symptom Reporting.

The overall goal of this work is to create a patient-reported outcome (PRO) and decision support system to help postpartum patients determine when to seek care for concerning symptoms. In this case study, we assessed differences in perspectives for application design needs based on race, ethnicity, and preferred language. A sample of 446 participants who reported giving birth in the past 12 months was recruited from an existing survey panel. We sampled participants from four self-reported demographic groups: (1) English-speaking panel, Black/African American race, non-Hispanic ethnicity; (2) Spanish-speaking panel, Hispanic-ethnicity; (3) English-speaking panel, Hispanic ethnicity; (4) English-speaking panel, non-Black race, non-Hispanic ethnicity. Participants provided survey-based feedback regarding interest in using the application, comfort reporting symptoms, desired frequency of reporting, reporting tool features, and preferred outreach pathway for concerning symptoms. Fewer Black participants, compared with all other groups, stated that they had used an app for reporting symptoms (p = 0.02), were least interested in downloading the described application (p < 0.05), and found a feature for sharing warning sign information with friends and family least important (p < 0.01). Black and non-Hispanic Black participants also preferred reporting symptoms less frequently as compared with Hispanic participants (English and Spanish-speaking; all p < 0.05). Spanish-speaking Hispanic participants tended to prefer calling their professional regarding urgent warning signs, while Black and English-speaking Hispanic groups tended to express interest in using an online chat or patient portal (all p < 0.05) CONCLUSION: Different participant groups described distinct preferences for postpartum symptom reporting based on race, ethnicity, and preferred languages. Tools used to elicit PROs should consider how to be flexible for different preferences or tailored toward different groups.