Preferred Language Research Articles

Developing an implementation intervention, and identifying strategies for integrating health innovations in routine practice: A case study of the implementation of an insulin patient decision aid.

Implementation, which is defined as the process of getting evidence-based innovation to be utilised is critical in ensuring innovation is being integrated into real-world practice. The way an implementation intervention (i.e., a bundle of strategies to facilitate implementation) is developed has an impact on the types of strategies chosen, and whether they are relevant to the implementation setting to exert their effects. However, literature pertaining to development of intervention or detailed descriptions of implementation processes are scarce. This study aims to report the development of an implementation intervention to integrate the use of an evidence-based innovation in routine practice, using a Malaysian insulin patient decision aid (PDA) as an exemplar. The development of the insulin PDA implementation intervention was divided into two phases, incorporating step 3 and 4 of the Action Cycle in the Knowledge to Action framework. In Phase 1, barriers to the insulin PDA implementation was explored through qualitative interviews using an interview guide developed based on the Theoretical Domains Framework. In Phase 2, prioritisation of the barriers was conducted using the multivoting technique. Next, potential strategies that can address the barriers were identified based on understanding the clinic context, and evidence from literature. Then, the selected strategies were operationalised by providing full descriptions in terms of its actor, action, action target, temporality, dose, implementation outcome affected, before they were embedded into the patient care pathway in the clinic. The implementation intervention was finalised through a clinic stakeholders meeting. In Phase 1, a total of 15 focus group discussions and 37 in-depth individual interviews were conducted with: healthcare policymakers (n = 11), doctors (n = 22), diabetes educators (n = 8), staff nurses (n = 6), pharmacists (n = 6), and patients (n = 31). A total of 26 barriers and 11 facilitators emerged and they were categorised into HCP, patient, organisational, and innovation factors. The multivoting exercise resulted in the prioritisation of 13 barriers, and subsequently, a total of 11 strategies were identified to address those barriers. The strategies were mandate change, training workshop, involve patients' family members or caretakers, framing/reframing, inform healthcare providers on the advantages of the insulin PDA use, define roles and responsibilities, place the insulin PDA in the consultation room, provide feedback, systematic documentation, to engage patients in treatment discussions, and juxtapose PDA in preferred language with patient's PDA in their preferred language to help with translation. This study highlights main barriers to PDA implementation, and strategies that can be adopted for implementation. The steps for intervention development in this study can be compared with other intervention development methods to advance the field of implementation of evidence-based innovations.

Abstract 4138482: The burden of ischemic heart disease, hypertension, diabetes mellitus, and obesity among older Latino and Chinese adults with and without limited English proficiency

Background: An estimated 15% of Latinos and 34% of Chinese in the US have limited English proficiency (LEP). However, there is limited information on whether ischemic heart disease (IHD) and its risk factors (hypertension, HTN; diabetes mellitus, DM; and obesity) vary by LEP vs. non-LEP status in these ethnic groups. This information may be valuable for targeting healthcare interventions. METHODS: This cross-sectional study used data for Latino (79,588 men, 85,560 women), and Chinese (25,944 men, 32,586 women) adults aged 50-79 years who were members of a northern California health plan in 2018-2019. Age, sex, language preference, obesity (BMI ≥30 for Latino and ≥27.5 kg/m2 for Chinese), and IHD, HTN, and DM diagnoses were abstracted from electronic health records. LEP was defined as Spanish/Chinese vs. English (non-LEP) language preference. Prevalence was compared by LEP status within age-sex groups. Modified Poisson regression was used to estimate age-adjusted prevalence ratios. RESULTS: Among Latino men aged 50-64 (57,835, 39% LEP) and 65-79 (21,753, 30% LEP) and Chinese men aged 50-64 (14,751, 42% LEP) and 65-79 (11,193, 40.3% LEP) years, IHD prevalence was lower in LEP vs. non-LEP (Latino: 3.5% vs. 6.0% and 13.8% vs. 19.0%; Chinese: 3.6% vs. 5.8% and 11.9% vs. 14.5%). Similar trends were observed in women, but IHD prevalence was much lower. Among Latino and Chinese men, HTN and obesity prevalence was lower, but DM was similar. For women, HTN was similar, but DM was higher in LEP Latina (age 50-79) and Chinese adults (age 65-79), while obesity was lower in LEP Chinese but not Latina adults. Differences remained after adjusting for age (aPR). CONCLUSION: The burden of IHD, HTN, and obesity is similar or lower among LEP vs. non-LEP Latino and Chinese adults, while the burden of DM is higher for LEP vs. non-LEP Latina and Chinese women. These findings suggest that while DM prevalence is already high, acculturation is associated with higher risk of developing some chronic CVD conditions, underscoring the need for targeted healthcare interventions. Further research is needed to explore mechanisms driving these disparities and to develop culturally appropriate strategies to improve health outcomes.

Food insecurity in a diverse community pediatric gastroenterology clinic: Screening strategies and insights.

We aimed to evaluate the prevalence of food insecurity (FI) in the community pediatric gastroenterology(GI) subspecialty clinic at Texas Children's Hospital (TCH) West Campus and to assess the utilization of services through our partnership with a local food bank. From July 1, 2023, to February 29, 2024, all patients seen in the pediatric GI clinic at TCH West Campus were screened for FI using the validated Hunger Vital Sign tool and given the opportunity to consult with a local food bank representative. A retrospective chart review was then performed on patients who completed the implemented FI screening process. 13.4% of the total patients screened positive for FI. Hispanic patients (p < 0.0001), patients with the preferred language of Spanish (p < 0.0001), those enrolled in Medicaid or Children's Health Insurance Program (p < 0.0001), and patients with obesity (body mass index ≥ 30.0, p = 0.0003) were more likely to screen positive for FI. Poor weight gain/failure to thrive and steatotic liver disease were significantly more common in those with FI (p < 0.0001 and p = 0.0003, respectively), while celiac disease, abdominal pain, and blood in stool were more common in those without FI (p = 0.0003, 0.0475, and 0.0404, respectively). As a result of our implemented FI screening process, 68.4% of those screening positive opted for resource referral, with 50.7% successfully receiving assistance in combating FI. Identifying the potential impact of FI in common pediatric GI conditions calls for proactive screening and more holistic, patient-centered approaches in clinical practice.

Cancer Clinical Trial Participation Amongst Culturally and Linguistically Diverse Patients in Australia.

Clinical trials play a large role in oncological. Many barriers to participation in cancer clinical trials exist, including a patient's status as "culturally and linguistically diverse (CALD)". Globally, it is thought that CALD patients experience lower rates of trial participation, although very few studies quantify rates of cancer clinical trial participation in this group. Our study therefore aims to characterize CALD participation in cancer clinical trials in an Australian setting. We conducted a retrospective analysis of data from the Cancer Clinical Trials Centre at Austin Health, a large tertiary metropolitan cancer center in Melbourne, Australia. Participation in cancer clinical trials between groups was compared using simple descriptive analysis, Chi-squared analysis, and logistic regression. Of 2568 patients (mean age 57.9 years, 37% female) offered entry into a cancer clinical trial between 2018 and 2023, 26% were from a CALD background (n = 678), and 9% had a preferred language other than English (n = 219). A greater proportion of non-CALD patients participated in a cancer clinical trial compared with CALD patients (37% versus 33% respectively, p =0.04). In logistic regression models, Arabic (OR,0.46; 95% CI,0.21-0.93 [univariate]) and Greek (OR,0.54; 95% CI,0.31-0.91 [multivariate]) language groups, along with overall CALD status (OR,0.81; 95% CI,0.67-0.99 [univariate]) were associated with lower cancer clinical trial participation. We found that CALD patients, those born in non-English speaking countries, and specific language groups, were associated with lower cancer clinical trial participation.

Sociodemographic Predictors of Keratoconus (Severity, Treatment, and Progression) in a Tertiary Center in New York City.

To identify sociodemographic factors as predictors of keratoconus severity, progression, disease outcomes, and appropriate management in a tertiary care ophthalmology institute in the New York City metropolitan area. This is a retrospective chart review. Patients with keratoconus presenting at a tertiary eye institute in an urban setting seen between 2015 and 2022 were included. Sociodemographic data including age, sex, race, ethnicity, income derived from zip code, insurance coverage, and preferred language were recorded. These sociodemographic factors were analyzed as possible predictors of keratoconus severity at presentation (Amsler-Krumeich grades III and IV): patients presenting with acute hydrops, patients receiving corneal cross-linking or corneal transplant, patients showing 1 or more diopters of increase of Kmax during their follow-up, and patients having longer time between the provider's recommendation of corneal cross-linking and the time of the procedure. The retrospective review included 634 patients with a clinical diagnosis of keratoconus. Factors associated with severe keratoconus at presentation in the multivariate analysis were non-White (P < 0.001), lowest income (Q1) (P = 0.018), Q2 income (P = 0.012), and having Medicaid/Medicare coverage (P = 0.021). Medicaid/Medicare coverage was the only factor associated with acute hydrops (P < 0.001), and younger age was the only factor associated with disease progression (P < 0.001). Younger patients and patients with commercial insurance coverage were more likely to receive corneal collagen cross-linking (P < 0.001 and P < 0.001, respectively), whereas patients with Medicaid/Medicare coverage, lowest income, and non-White race were more likely to receive corneal transplantation (P = 0.012, P = 0.062, and P = 0.028, respectively). Medicaid/Medicare was the only factor associated with delay in receiving corneal collagen cross-linking (P = 0.013). Our study demonstrates that there are sociodemographic predictors of keratoconus disease severity, progression, and the type and the time of treatment the patients received. This confirms eye health disparities among patients with keratoconus.

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.

Examining the association between professional language interpreter services and intensive care unit utilization among patients with non-English language preference: Evidence from a large U.S. hospital

ObjectiveTo examine the healthcare utilization of patients with non-English language preference (NELP) who utilized a professional language interpreter (PLI) in the intensive care unit (ICU) compared to similar patients with NELP who did not utilize a PLI in the ICU. MethodsSingle center cohort study of patients with NELP with at least one ICU admission a large academic medical center in the U.S. Midwest (1/1/2008-12/31/2022). The first model examined ICU length-of-stay (LOS) using a negative binomial and the second model examined whether a patient was readmitted to the ICU using a logistic regression with each model controlling for PLI utilization and covariates. ResultsPatients with NELP who utilized a PLI in the ICU had 0.87-days longer in the ICU (p<0.01) and had a 46% decreased odds of being readmitted to the ICU (p<0.01) than a comparable patient with NELP who did not utilize a PLI in the ICU. ConclusionProviding patients with NELP with access to a PLI in the ICU can improve patient outcomes and reduce language barriers. Practice implicationsThese results can provide the justification to potentially increase PLI staffing levels or increase the access to existing PLIs for more patients with NELP in ICUs.

Psychosocial Dimensions of Pain Disparities in Youth Diagnosed with Unspecified Abdominal Pain in an Emergency Department

Diagnosis ambiguity, paired with pain care inequities experienced by marginalized groups may increase risk for ongoing pain and impairment in children diagnosed with unspecified abdominal pain in the pediatric emergency department (PED). This cross-sectional study examined psychological, caregiver, cultural, and socio-ecological factors associated with pain-related impairment in an ethnically and socioeconomically diverse population diagnosed with unspecified abdominal pain in a PED. The sample included 111 children 8-17 years old (59.8% female, 72.7% Latinx) and their caregivers. Exclusion criteria included an Emergency Severity Index <2, psychiatric complaint, or not fluent in English or Spanish. Children completed the PROMIS Pain Interference Scale and reported pain intensity, pain duration, and pain catastrophizing. Caregivers reported language preference, pain catastrophizing, trait anxiety, and child internalizing symptoms. Area Deprivation Index quantified socio-ecological deprivation according to 9-digit zip code. Multivariable logistic regression analyses identified independent associations with likelihood of reporting severe levels of pain-related impairment. Approximately 35.3% of children reported severe levels of pain-related impairment. In logistic regression analysis, an increased likelihood of endorsing severe pain-related impairment was associated with pain for >1 month (OR=9.19, p=.044), higher child pain catastrophizing (OR=1.23, p<.001), caregiver Spanish language (OR=11.11, p=.044), and clinically significant caregiver trait anxiety (OR=58.16, p=.004). Results highlight the incidence of severe pain-related impairment in children diagnosed with unspecified abdominal pain in a PED. Moreover, findings underscore the importance of screening pain-related impairment and caregiver anxiety, and addressing language barriers in this PED population. PerspectiveThis paper highlights the incidence of severe pain-related impairment among pediatric patients diagnosed with unspecified abdominal pain in a pediatric emergency department (PED). Results could inform early assessment and targeted interventions in the PED to prevent outcome disparities.

Outcomes of Ophthalmology Telemedicine in a Large Health Care System Beyond Initial Pandemic Crisis

PurposeTo compare the outcome of telemedicine versus in-person visit in a large health care system. DesignRetrospective cohort study. Methods174,245 patients with a telemedicine or in-person visit from September 2020 to June 2021 in the Kaiser Permanente Northern California Health Care System were included. Main outcome measures were whether an initial telemedicine or in-person visit required a subsequent in-person visit and patient characteristics that differed between telemedicine and in-person groups. Charts of selected televisits with return in-person visits were reviewed for diagnostic accuracy of telemedicine. Results27% of patients who had telemedicine visit had a subsequent in-person visit compared to 13% of patients who had initial in-person visit. Telemedicine visit was associated with higher risk of needing a subsequent in-person visit compared to an initial in-person visit (RR 2.35, CI 2.30-2.40). Patient characteristics associated with higher risk of telemedicine visit compared to in-person visit included female gender (RR 1.07, CI 1.05-1.08), Asian/Black/Hispanic/other race (RRAsian 1.06, CI 1.04-1.08; RRBlack 1.07, CI 1.04-1.11; RRHispanic 1.03, CI 1.02-1.05; RROther 1.04, CI 1.03-1.06,), and English language preference (RR 1.08, CI 1.04-1.11). Age had bimodal distribution with patients younger than 18 and 65 and older associated with less usage of telemedicine. Diagnostic accuracy of telemedicine was 93%. ConclusionsAlthough telemedicine visit was associated with higher risk of needing return in-person visits, telemedicine was able to address ophthalmic needs in majority of patients with high diagnostic accuracy. This large health care system study supports the continued used of telemedicine in ophthalmology in post pandemic setting.

Drowsy driving prevalence and beliefs among a nationally representative US sample: A report from the National Sleep Foundation

ObjectivesDrowsy driving is a preventable form of impaired driving, represents a large public health concern, and accounts for a significant proportion of motor vehicle crashes, injuries, and deaths. There is a limited body of research documenting the prevalence and frequency of drowsy driving, alongside the public’s perceptions and attitudes surrounding drowsy driving. The overarching goal of the present study was to document the prevalence, frequency, perceptions, attitudes, and associated sleep behaviors and beliefs related to drowsy driving. MethodsThe National Sleep Foundation conducted a national online survey of 1012 adults via the probability-based Ipsos Public Affairs KnowledgePanel. The survey was conducted in either English or Spanish, depending on participant preferred language. Respondents answered questions about the occurrence of drowsy driving, attitudes and beliefs about drowsy driving, and habitual sleep duration. ResultsResults indicated that the majority of US adults (95%) perceived drowsy driving as a risk; however, the lifetime prevalence of drowsy driving was high—62% of all drivers reported driving while so tired that they had a hard time keeping their eyes open. Individuals who obtained the NSF recommended sleep duration drove while drowsy less frequently. ConclusionsDrowsy driving is a preventable and common behavior at the intersection of sleep health and public safety. Drivers who get adequate nighttime sleep are less likely to drive while they are so tired that they have a hard time keeping their eyes open. Public health campaigns encouraging adequate sleep to drive alert are needed.

Migration and mental health: the case of postpartum depressive symptoms in Portugal

Abstract Background Postpartum depression (PPD) affects about 17% of healthy mothers within one year of childbirth. The etiology remains unknown, but PPD is influenced by a combination of genetic, physical, psychosocial, and obstetric factors, migration could influence the risk. Methods We analyzed data collected within the scope of baMBINO (Perinatal Health in Migrants: Barriers, Incentives, and Outcomes), a Portuguese prospective cohort study, aimed to investigate the maternity experiences and outcomes of migrant women, defined as foreign-born women, and compared to native women. Among the 5431 women enrolled at delivery, 3006 (55%) were considered eligible for this study and interviewed in their preferred language, within six months of recruitment. The Edinburgh Postnatal Depression Scale (EPDS) was administered during this interview, along with the Migrant-Friendly Maternity Care Questionnaire (MFMCQ). Results 2890 (96%) women were included in the analytical sample for this study. Among women included, 1475 (51%) were migrants or refugees. The proportions of women having EPDS scores ≥ 10 were overall greater among migrants than among native women (7.2% vs. 12.4%, p &amp;lt; 0.001) and the risk remained higher after multiple adjustment models. Conclusions Migration status, poor experience with maternal care and language proficiency increased the risk of PPDS and should be carefully addressed as part of perinatal care.

Effect of a cardiovascular post discharge sms support program on healthcare utilisation - the hearthealth program

Abstract Background Cardiovascular disease (CVD) is a leading cause of mortality worldwide[1]. Targeting modifiable risk factors is key to primary and secondary prevention of CVD but many barriers to good risk factor control exist[2]. SMS message programs have shown to be an efficient modality to deliver information to improve knowledge and risk factor profiles for CVD patients[3]; however, their impact on healthcare utilisation has not been thoroughly examined. The HeartHealth program is a text message post-discharge support program delivered to CVD patients. It comprised regular semi-personalised text messages providing CVD information, advice, and support to patients over a 6-month period. Purpose This study aimed to examine the impact of the Heart Health program on healthcare service utilisation. Methods Patients ≥18 years old who recently attended cardiology clinics or were discharged from a cardiology unit, between April 2020 and April 2022 were invited to the program. We compared healthcare utilisation rates in patients who enrolled into the HeartHealth text program (intervention group) to contemporaneous patients who did not enrol in the program (control group). The primary outcome was the incidence rate of all-cause healthcare utilisation events (composite of ED presentations and/or hospital admissions for any medical cause) in the 6 months post-discharge. The secondary outcomes were incidence rates of CVD events and unplanned CVD events. All analyses were adjusted for demographic and co-morbidity variables. Results 11542 patients were included in analysis (intervention: 4324, control: 7218), mean age 58.8 years, 60.7% were male, and 78.3% with English as their preferred language. HeartHealth Intervention participants had lower rates of the primary outcome of healthcare service events compared to control participants (mean number of events 0.43 intervention vs 0.52 control, adjusted rate ratio [RR], 0.91 [95% CI, 0.83-0.99], p=0.033, Table 1). The intervention was significantly more effective in older patients compared to younger patients (RR, 0.82, [95% CI, 0.72-0.93] in patients aged ≥65 years, compared to patients &amp;lt;65 years, RR, 0.98, [95% CI, 0.87-1.10]; p-value for interaction =0.043, Figure 1). The subset of CVD events and unplanned CVD events were numerically lowering in the intervention group compared to the control, but the risk ratio not statistically significantly different in adjusted models (Table 1). Conclusion This analysis demonstrates that a text message post-discharge support program for CVD patients decreased the need for healthcare service utilisation for all medical causes. Future randomised controlled trials are required to further support these findings.Figure 1:Adjusted interaction analysisTable 1:Adjusted Incidence of events

Improving Family-Centered Rounds With a Nursing Checklist in the Electronic Health Care Record.

Family-centered rounds (FCR) is the standard for pediatric communication, but community pediatric hospital medicine services may face barriers in implementation, including offering FCR to families with a language preference other than English (LOE) versus those with an English preference (EP). The goal of our quality improvement project was to increase FCR from 33% to 80% over 1 year. Interventions included an FCR checklist integrated into the electronic healthcare record (EHR-FCR checklist), staff education, visual prompts, and interpreters. Our primary outcome measure was weekly % FCR. Our main process measure was weekly % nursing documentation. To address language inclusion, we compared FCR encounters for families with LOE versus EP. The use of the checklist without interventions was assessed during the sustain period. Control charts were used to analyze measures. Fisher's exact test was used to compare FCR for families with LOE versus EP. FCR increased to 81% during the intervention period and then decreased to 73% during the sustain period. Nursing documentation increased to 93% with the EHR-FCR checklist implemented as a flowsheet. There was no statistical difference in the proportion of families with LOE versus EP who participated in FCR (84% versus 81%, P = .38) during the intervention period; a statistically higher proportion of families with LOE participated in FCR during the sustain period (87% vs 72%, P <.01). We increased documented FCR on our community pediatric hospital medicine service, including FCR for families with LOE, by implementing a nursing-completed EHR-FCR checklist supported by staff education, visual prompts, and interpreters.

Predictors of Outpatient and Inpatient Service Utilization Among Publicly-Insured Youth With Eating Disorders.

Although eating disorders (EDs) affect youth from all socioeconomic backgrounds, little is known about the treatment experiences of under-resourced youth with EDs. To address this gap, we examined patterns of outpatient and inpatient service utilization among publicly-insured youth with EDs in California and potential disparities for youth with additional marginalized identities. Participants were identified from the full sample of California Medicaid/Medi-Cal beneficiaries aged 7-18 with ≥ 1 service episode between January 1, 2014 and December 31, 2016. Claims data were extracted for youth with a full year of claims after the first known ED diagnosis (N = 3311) to analyze outpatient mental health, outpatient medical/physical, inpatient mental health, and inpatient medical/physical service use across ED diagnosis and demographic characteristics (sex, age, race/ethnicity, and preferred language). Outpatient individual and family therapy service utilization was low across ED diagnoses (4-7 individual therapy sessions and ≈5 family therapy sessions annually). Conversely, hospitalization rates were high, particularly among youth with anorexia nervosa (27.8%) and bulimia nervosa (30.0%). Youth with other specified feeding or ED had high medical service utilization, with more days of outpatient medical care and greater odds of medical hospitalization than youth with all other diagnoses. Latinx youth, Black youth, and boys tended to receive fewer services after accounting for diagnosis, with disparities particularly pronounced for Latinx youth. Publicly-insured youth with EDs in California experience high hospitalization rates but receive limited outpatient therapy. Additional research is needed to identify possible unmet needs and factors contributing to treatment disparities among these youth.

Evaluating a phone-based Interactive Voice Response system for reducing misinformation and improving malaria literacy

ABSTRACT In Burkina Faso, malaria remains a major issue despite the use of insecticide-treated nets (ITNs), especially in underserved communities. A study assessed a mobile phone-based Interactive Voice Response (IVR) service in local languages to improve malaria health literacy. A randomized trial compared users of the local language version with those using a French version. The results showed a 30.33% increase in knowledge, 21.77% in attitude, and 35.38% in practice among the local language group, while the French group had lower improvements. Key factors for adoption included usability, privacy, trust, and compatibility. Participants preferred local language and voice interfaces, with younger users favoring games and older ones preferring text-based interfaces. This study highlights the potential of local language IVR to effectively boost malaria health literacy and combat misinformation in underserved areas.

Person-first and identity-first disability language: Informing client centred care

BackgroundAddressing individuals with a disability can entail the use of person-first (person with a disability) or identity-first language (disabled person). However, there has been debate about use of these terms, yet there is a lack of evidence to inform preference across people with a broad range of health conditions, demographics, or health related factors. MethodsA 42-item survey measuring demographic and health condition factors, implicit and explicit preference for person-first and identity-first language use was open for completion by individuals with a self-reported health condition between July 7, 2021 and November 30, 2021. Recruitment was undertaken via posts on relevant social media sites and through community support and advocacy organisations. ResultsData analysis included responses from 875 valid surveys. Mean age of participants was 39.7 (SD: 13.7) years. There were 89 (10.2%) male, 637 female (72.8%) and 149 (17.0%) non-binary/other participants. When referring to themselves, participants most often reported use of identity first language (n = 335, 42.2%), followed by person-first language (n = 272, 34.1%), then both interchangeably (118, 23.7%). When referring to others, participants most often used person first language (n = 312, 39.4%), followed by both interchangeably (269, 34.0%), then identity-first language (n = 211, 26.6%). Disability language preference varied across health conditions, with participants with neurodevelopmental conditions most likely to use identity-first language and participants with digestive conditions most often preferencing person-first language. Participants who were younger and of non-binary gender preferred use of identity-first language. Appropriate use of identity-first language was rated significantly higher for people with a disability/health condition and family/friends than for third-party representatives, including healthcare professionals, educators, media and the general public. ConclusionFindings highlight the need to understand health condition and disability language preference in a more nuanced way to promote respectful language use when addressing people in the context of their disability/health condition.

34 Improving language concordant care in the paediatric emergency department

Abstract Background Paediatric patients and families with limited English proficiency (LEP) experience worse health outcomes. Use of professional medical interpreter services (IS) helps ensure that all patients receive high quality care, regardless of their preferred language of communication. Objectives The aim of this quality improvement (QI) study was to improve language concordant care within a paediatric emergency department (ED) in downtown Toronto by increasing the rate of over-the-phone interpreter use by 50% by July 2024 and to understand common reasons for interpreter non-use. Design/Methods Using the model for improvement, we assembled an interdisciplinary team that included physicians, ED registration clerks, triage nurses, and language services staff to understand current workflow and develop targeted interventions aimed at addressing key drivers through multiple plan-do-study-act (PDSA) cycles. Interventions included introduction of a standardized script to capture language preference at ED registration, EMR-integrated preferred language notification and smart text template in provider notes for standardized IS use or non-use documentation, and departmental education. Our primary outcome measure was rate of over-the-phone IS use for all ED visits. Process measures were rate of EMR documentation of patients and caregivers with non-English language preference (NELP) and rate of provider documentation of IS use or non-use. Balancing measures included time to provider initial assessment (PIA) and ED length of stay. Results The baseline period (November 2022-April 2023) revealed an over-the-phone IS rate of 5.2% for all ED visits. The initial results from the first 6 months of the intervention period demonstrated an increase in physician documentation of IS use or non-use in patients with NELP, from 10% to 76%. Additionally, 18.6% of patients or caregivers with NELP had IS use per provider notes. Over the next 9 months of the intervention period, special cause variation is anticipated in the rate of IS use and rate of EMR documentation of NELP. The most common reasons for IS non-use were: ‘deemed unnecessary by provider’, ‘declined by family’ and ‘use of family member/friend as interpreter’. There was no change in PIA or ED length of stay for patients with NELP. Conclusion This QI initiative increased consistent provider documentation of IS use in ED patient records in one of the most linguistically diverse cities in the world. Future efforts will focus on exploring additional ways to capture language preference beyond registration, facilitating IS use in the ED, and addressing top reasons for non-use of IS in patients and caregivers with NELP.

What's in a treatment name? How people with posttraumatic stress disorder (PTSD) symptoms interpret and react to PTSD treatment names.

Prior research has rarely examined how people understand or react to the names of psychological treatments. In the case of evidence-based psychotherapies for posttraumatic stress disorder (PTSD), such reactions may be relevant to the low rates of uptake of such treatments. Participants who screened positive for PTSD (n = 887) completed questions assessing their initial reactions to PTSD treatment names as well as how a different name would affect their openness to treatment. In addition, they gave brief responses to open-ended questions about the reason for their initial reactions, and content analysis was used to better understand these reasons. The results indicated that among the treatment name options, cognitive processing therapy (CPT) and present-centered therapy (PCT) were viewed most positively. Approximately 40% of the sample preferred plain language alternatives for treatment names. Content analyses focused on descriptions of the treatments-which could be accurate or inaccurate-as well as whether respondents evaluated a treatment name itself as positive or negative. Some names conveyed treatments more accurately (e.g., CPT and written exposure therapy) than others (e.g., eye movement desensitization and reprocessing and prolonged exposure [PE]). Some names were also evaluated more positively (e.g., PCT) than others (e.g., PE). The general term "trauma-focused therapy" was seen as positive and clear. Addressing the ways patients react to psychological terms and treatment names could help clarify misperceptions about evidence-based psychotherapies and promote more widespread uptake of effective treatments for PTSD.

Improving Hospital-to-Home for Medically Complex Children: Views From Spanish-Speaking Caregivers.

Children with medical complexity (CMC) experience increased risk of adverse events during and after hospitalization, and these risks are even greater for CMC whose caregiver has a preferred language other than English. Because many adverse events for CMC may be attributable to communication challenges, understanding caregiver and physician perspectives may help prevent adverse events. We conducted semistructured interviews with Spanish-speaking caregivers of hospitalized CMC and their inpatient attending physicians. Each interview was conducted 24 to 72 hours after hospital discharge. Interviews continued until thematic sufficiency was reached. Interviews were audio recorded, transcribed, and translated verbatim. Investigators independently coded and reconciled codes using constant comparison to develop themes via inductive thematic analysis. We conducted 28 interviews (14 caregivers, 14 physicians). Three themes were identified: (1) barriers exist in providing language-concordant care in planning for transitions from hospital-to-home; (2) both physicians and caregivers perceived logistical challenges in using interpreters at the point of care; and (3) many caregivers felt uncomfortable asking physicians questions related to their child's medical management because of their language barrier. Participants also offered strategies to improve the transition from hospital to home: (1) empower families to ask questions and take notes, (2) consider the use of medical educators, and (3) improve the ability of hospital-based physicians to follow up with patients after discharge. Physicians strive for language-concordant care at each stage of discharge planning. However, unresolved gaps such as the lack of interpreter availability during medical-device education, require attention to promote safe transitions from hospital to home.