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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 17 of 17 Research Studies DisplayedDiMeo A, Karlage A, Schoenherr K
Cultural brokering in pregnancy care: a critical review.
This study is a literature review of cultural brokering during pregnancy. The authors identified 33 articles in their literature search. They found that cultural brokering is not clearly defined in the current literature. Only a few articles provided information about language concordance between cultural brokers and patients or clinicians, with no articles describing the impact of cultural brokering on health outcomes. Cultural broker facilitating was described as providing information about language concordance between cultural brokers and patients or clinicians. Barriers included misunderstanding the responsibilities, difficulty maintaining personal boundaries, and limited availability and accessibility of cultural brokers. They propose cultural brokering as interactions that cover four key aims: (1) language support; (2) bridging cultural differences; (3) social support and advocacy; and (4) navigation of the healthcare system.
AHRQ-funded; HS026370.
Citation: DiMeo A, Karlage A, Schoenherr K .
Cultural brokering in pregnancy care: a critical review.
Int J Gynaecol Obstet 2023 Nov; 163(2):357-66. doi: 10.1002/ijgo.15063..
Keywords: Maternal Care, Women, Clinician-Patient Communication, Cultural Competence
Hsueh L, Huang J, Millman AK
Cross-sectional association of patient language and patient-provider language concordance with video telemedicine use among patients with limited English proficiency.
The surge in telemedicine use during the COVID-19 pandemic underscores the need to address gaps in patient care, particularly for individuals with limited English proficiency. The purpose of this study was to investigate the relationship between patient language, patient-provider language alignment, and the type of telemedicine visit (video or phone consultation). The researchers conducted a cross-sectional analysis using automated data from primary care telemedicine appointments scheduled between March 16, 2020, and October 31, 2020 within a comprehensive healthcare delivery system in Northern California. A total of 22,427 completed primary care telemedicine visits booked by 13,764 patients with limited English proficiency through the patient portal. The study examined the cross-sectional link between electronic health record-documented patient language (with Spanish as the reference) and patient-provider language concordance, considering patient demographics, technology access, and technology familiarity. RESULTS: The study found that among all scheduled appointments, 34.5% (n=7747) were video consultations. The three most common patient languages were Spanish (42.4%), Cantonese (16.9%), and Mandarin (10.3%). After adjusting for demographic and technology factors, video visit usage was higher for patients speaking Cantonese, Mandarin, or Vietnamese, compared to Spanish-speaking patients, but lower for those who spoke Punjabi. Language concordance was linked to decreased video visit utilization and influenced the relationship between speaking Spanish, Cantonese, and Korean with video visit usage. Furthermore, for all language groups, patients with prior video visit experience were more likely to use video visits again.
AHRQ-funded; HS025189
Citation: Hsueh L, Huang J, Millman AK .
Cross-sectional association of patient language and patient-provider language concordance with video telemedicine use among patients with limited English proficiency.
J Gen Intern Med 2023 Feb;38(3):633-40. doi: 10.1007/s11606-022-07887-6.
Keywords: Telehealth, Health Information Technology (HIT), Cultural Competence, Clinician-Patient Communication, Communication, Healthcare Delivery, COVID-19
Jensen JL, Sweeney A, Gill C
Evaluation of patient access to Spanish-language-concordant care on a postpartum unit.
This study evaluated patient access to Spanish-language-concordant care on a postpartum unit and to identify facilitators and barriers to the use of interpretation services. This mixed-methods study included a chart review of 50 randomly selected birthing parent-newborn couplets and interviews with 14 inpatient health care team members, and semistructured interviews at a tertiary academic medical center in the southeastern United States. The chart review included examination of patient characteristics, health care team composition including Spanish language proficiency, length of stay, number of interpreter requests, and time between clinician interpreter requests and interpreter arrival on the unit. Access to an interpreter or clinician certified in medical Spanish was offered to 12 of 50 (24%) couplets upon admission to the unit and to 7 of 50 (14%) of couplets for daily maternal and newborn medical rounds. Clinicians reported on long and unpredictable wait times to access interpreters. Temporary solutions included relying on hand gestures, broken Spanish, and smartphone apps to "get by" when communicating with patients without certified interpretation services. These deviations from national standards may put postpartum families at risk for harm.
AHRQ-funded; HS027260.
Citation: Jensen JL, Sweeney A, Gill C .
Evaluation of patient access to Spanish-language-concordant care on a postpartum unit.
Nurs Womens Health 2022 Dec;26(6):429-38. doi: 10.1016/j.nwh.2022.09.002.
Keywords: Maternal Care, Cultural Competence, Clinician-Patient Communication, Communication
Gutman CK, Lion KC, Fisher CL
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
The authors discuss the issue of individuals with limited English proficiency (LEP) and the high risk for adverse outcomes in the US health care system, especially in the emergency department. They point out that, although professional language interpretation improves the quality of care for these patients, it remains underused. They find few examples in the literature of rigorous interventions to improve quality of care and outcomes for patients with LEP and urge further high-quality research to improve communication with patients with LEP along the continuum of emergency care in order to achieve equity in outcomes.
AHRQ-funded; HS026006.
Citation: Gutman CK, Lion KC, Fisher CL .
Breaking through barriers: the need for effective research to promote language-concordant communication as a facilitator of equitable emergency care.
J Am Coll Emerg Physicians Open 2022 Feb;3(1):e12639. doi: .
Keywords: Communication, Emergency Department, Cultural Competence, Clinician-Patient Communication
Choe AY, Schondelmeyer AC, Thomson J
Improving discharge instructions for hospitalized children with limited english proficiency.
Research was conducted on an intervention for patients with limited English proficiency (LEP) who are discharged from the hospital without instructions in their preferred language. The objective was to increase the percentage of patients with LEP on the hospital medicine service who received translated discharge instructions from 12% to 80%. During the 18-month study period 540 patients with LEP were discharged. Spanish was the preferred language of 66% of these patients. The percentage of patients who received translated discharge instructions increased from 12% to 50% in 3 months, and to 77% in 18 months. For Spanish-language patients, the percentage increased to 96% by 18 months.
AHRQ-funded; HS026763; HS025138.
Citation: Choe AY, Schondelmeyer AC, Thomson J .
Improving discharge instructions for hospitalized children with limited english proficiency.
Hosp Pediatr 2021 Nov;11(11):1213-22. doi: 10.1542/hpeds.2021-005981.
AHRQ-funded; HS026763; HS025138..
AHRQ-funded; HS026763; HS025138..
Keywords: Children/Adolescents, Hospital Discharge, Clinician-Patient Communication, Cultural Competence, Communication
Kirby JB, Berdahl TA, Stone RA
AHRQ Author: Kirby JB, Berdahl TA
Perceptions of patient-provider communication across the six largest Asian subgroups in the USA.
Investigators sought to estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups. Using MEPS data, they found that negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. They recommended that researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care avoid categorizing all Asians into a single group.
AHRQ-authored.
Citation: Kirby JB, Berdahl TA, Stone RA .
Perceptions of patient-provider communication across the six largest Asian subgroups in the USA.
J Gen Intern Med 2021 Apr;36(4):888-93. doi: 10.1007/s11606-020-06391-z..
Keywords: Medical Expenditure Panel Survey (MEPS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), Clinician-Patient Communication, Communication, Patient Experience, Racial and Ethnic Minorities, Cultural Competence
Rodriguez JA, Fossa A, Mishuris R
Bridging the language gap in patient portals: an evaluation of Google Translate.
Due to communication barriers, limited English-proficient (LEP) patients face challenges in the healthcare system. Given the language divide, the investigators sought to assess the use of Google Translate (GT) in the clinical setting and compare its efficacy to traditional human translation of patient messages. The investigators translated the messages to English using a professional translator and GT and created a series of clinical comprehension questions based on the message content.
AHRQ-funded; HS021495.
Citation: Rodriguez JA, Fossa A, Mishuris R .
Bridging the language gap in patient portals: an evaluation of Google Translate.
J Gen Intern Med 2021 Feb;36(2):567-69. doi: 10.1007/s11606-020-05719-z..
Keywords: Cultural Competence, Clinician-Patient Communication, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT)
Canedo JR, Wilkins CH, Senft N
Barriers and facilitators to dissemination and adoption of precision medicine among Hispanics/Latinos.
This study examined barriers to dissemination and adoption of precision medicine among the Hispanic/Latino population. Six focus groups and a demographic survey in English and Spanish was developed. Forty-one self-identified Hispanics/Latinos from diverse countries participated in the study. The participants had never heard of precision medicine and barriers to adoption and dissemination included lack of health insurance, distrust of government, immigration status, financial burden, limited English proficiency, low literacy levels, lack of information and lack of transportation. Facilitators included family support, information provided in Spanish, use of plain language and graphics and trust in healthcare providers and institutions. The authors recommend culturally- and linguistically-tailored, low-literacy educational material about precision medicine in English and Spanish.
AHRQ-funded; HS026122.
Citation: Canedo JR, Wilkins CH, Senft N .
Barriers and facilitators to dissemination and adoption of precision medicine among Hispanics/Latinos.
BMC Public Health 2020 May 1;20(1):603. doi: 10.1186/s12889-020-08718-1..
Keywords: Racial and Ethnic Minorities, Cultural Competence, Health Literacy, Education: Patient and Caregiver, Clinician-Patient Communication
Hale KL, Wallace DD, Blanco-Duran D
Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs.
The authors evaluated shared decision-making (SDM) and delineated SDM processes in audio-recorded conversations between language-congruent Spanish-/English-speaking clinicians and parents of pediatric mental health patients. They found that their present sample performed on par with other populations studied to date, and that it expanded the evaluation of observed SDM to include Latino patients and new clinician populations. The practical implications of their findings is that use of the Observer OPTION(5) instrument highlights that eliciting and integrating parent/patient preferences is a skill that requires attention when delivering culturally competent interventions.
AHRQ-funded; HS000032.
Citation: Hale KL, Wallace DD, Blanco-Duran D .
Conversations between Latina mothers and their child's mental health provider: An observational study of shared decision-making regarding pediatric patient mental health needs.
Patient Educ Couns 2020 Jan;103(1):96-102. doi: 10.1016/j.pec.2019.08.013..
Keywords: Children/Adolescents, Shared Decision Making, Cultural Competence, Racial and Ethnic Minorities, Clinician-Patient Communication, Communication, Caregiving, Behavioral Health
Khan A, Yin HS, Brach C
AHRQ Author: Brach C
Association between parent comfort with English and adverse events among hospitalized children.
The purpose of this study was to examine the association between parents’ limited comfort with English (LCE) and adverse events in a cohort of hospitalized children. Participants included Arabic-, Chinese-, English-, and Spanish-speaking parents of patients 17 years and younger in the pediatric units of seven North American hospitals. Findings showed that hospitalized children of parents expressing LCE were twice as likely to experience harms due to medical care. Targeted strategies are needed to improve communication and safety for this vulnerable group of children.
AHRQ-authored; AHRQ-funded; HS022986.
Citation: Khan A, Yin HS, Brach C .
Association between parent comfort with English and adverse events among hospitalized children.
JAMA Pediatr 2020 Dec;174(12):e203215. doi: 10.1001/jamapediatrics.2020.3215..
Keywords: Children/Adolescents, Caregiving, Cultural Competence, Clinician-Patient Communication, Communication, Adverse Events, Patient Safety, Inpatient Care, Hospitalization
Choe AY, Unaka NI, Schondelmeyer AC
Inpatient communication barriers and drivers when caring for limited english proficiency children.
The authors identified barriers to and drivers of effective interpreter service use when caring for hospitalized limited English proficiency (LEP) children from the perspectives of pediatric medical providers and interpreters. Using Group Level Assessment, they found that participants identified unique barriers and drivers that impact communication with LEP patients and their families during hospitalization. They suggested that future directions include exploring the perspective of LEP families and utilizing team-based and family-centered communication strategies to standardize and improve communication practices.
AHRQ-funded; HS025138.
Citation: Choe AY, Unaka NI, Schondelmeyer AC .
Inpatient communication barriers and drivers when caring for limited english proficiency children.
J Hosp Med 2019 Oct;14(10):607-13. doi: 10.12788/jhm.3240..
Keywords: Clinician-Patient Communication, Communication, Cultural Competence, Children/Adolescents, Inpatient Care, Patient and Family Engagement, Caregiving
Berdahl TA, Kirby JB
AHRQ Author: Berdahl TA, Kirby JB
Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015.
The purpose of this study was to describe trends in patient-provider communication by limited English proficiency (LEP) from 2006 to 2015. The investigators concluded that although patient-provider communication among LEP individuals improved since 2010, linguistic disparities persist and constitute a formidable challenge to achieving healthcare equity, a long-standing US policy goal.
AHRQ-authored.
Citation: Berdahl TA, Kirby JB .
Patient-provider communication disparities by limited English proficiency (LEP): trends from the US Medical Expenditure Panel Survey, 2006-2015.
J Gen Intern Med 2019 Aug;34(8). doi: 10.1007/s11606-018-4757-3..
Keywords: Clinician-Patient Communication, Communication, Cultural Competence, Disparities, Medical Expenditure Panel Survey (MEPS)
Khoong EC, Cherian R, Matta GY
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
The goal of this study was to understand how safety-net patients, including those with limited English proficiency, view clinician electronic health record (EHR) use. Through focus groups in English, Spanish, and Cantonese, results showed that linguistically diverse patients accepted the value of EHR use during outpatient visits but desired more eye contact, verbal warnings before EHR use, and screen-sharing. Support for clinicians in completing EHR-related tasks during the visit using patient-centered strategies for all patients is recommended.
AHRQ-funded; HS022561; HS023558; HS022408.
Citation: Khoong EC, Cherian R, Matta GY .
Perspectives of English, Chinese, and Spanish-speaking safety-net patients on clinician computer use: qualitative analysis.
J Med Internet Res 2019 May 22;21(5):e13131. doi: 10.2196/13131..
Keywords: Cultural Competence, Racial and Ethnic Minorities, Patient Experience, Electronic Health Records (EHRs), Health Information Technology (HIT), Clinician-Patient Communication, Health Literacy, Communication
Lion KC, Kieran K, Desai A
Audio-recorded discharge instructions for limited English proficient parents: a pilot study.
Parents with limited English proficiency (LEP) demonstrate lower comprehension of discharge instructions. This study was conducted to (1) determine the feasibility of providing a greeting card with language-specific, audio-recorded discharge instructions to LEP parents; (2) describe use of and satisfaction with the cards; and (3) evaluate card effect on instruction comfort with home care and comprehension. The authors concluded that providing language-concordant, audio-recorded discharge instructions was feasible, and parents reported high satisfaction with and frequent use of the cards with multiple caregivers.
AHRQ-funded; HS024299.
Citation: Lion KC, Kieran K, Desai A .
Audio-recorded discharge instructions for limited English proficient parents: a pilot study.
Jt Comm J Qual Patient Saf 2019 Feb;45(2):98-107. doi: 10.1016/j.jcjq.2018.06.001..
Keywords: Hospital Discharge, Cultural Competence, Clinician-Patient Communication, Communication, Education: Patient and Caregiver
Squires A
Evidence-based approaches to breaking down language barriers.
This article provides background information about language barriers between nurses and patients and some strategies for addressing these gaps. After detailing how these barriers affect patient outcomes, practice-based strategies are offered to improve outcomes and reduce readmissions. Although the article doesn’t address barriers to communicating with patients with hearing loss, many of the same principles apply to these patients.
AHRQ-funded; HS023593.
Citation: Squires A .
Evidence-based approaches to breaking down language barriers.
Nursing 2017 Sep;47(9):34-40. doi: 10.1097/01.NURSE.0000522002.60278.ca.
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Keywords: Communication, Cultural Competence, Evidence-Based Practice, Nursing, Clinician-Patient Communication
Squires A, Peng TR, Barrón-Vaya Y
An exploratory analysis of patient-provider language-concordant home health care visit patterns.
In a 2-year period, this study showed that among the 238,513 visits with 18,132 limited English proficiency patients, only 20 percent of visits were language concordant. The study suggests that home health care services may not be meeting the demand for language services, but more research is needed to determine the right “dose” of bilingual home care visits to optimize home care outcomes and establish a standard for care.
AHRQ-funded; HS023593.
Citation: Squires A, Peng TR, Barrón-Vaya Y .
An exploratory analysis of patient-provider language-concordant home health care visit patterns.
Home Health Care Management & Practice 2017 Aug 1;29(3):161-67. doi: 10.1177/1084822317696706.
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Keywords: Cultural Competence, Home Healthcare, Clinician-Patient Communication, Racial and Ethnic Minorities, Urban Health
Wen KY, Hu A, Ma GX
Information and communication needs of Chinese American breast cancer patients: perspectives on survivorship care planning.
The researchers conducted a qualitative study to examine the information and communication needs as well as survivorship care preferences of Chinese American breast cancer survivors. The main themes identified through analysis of interview transcripts were: the need for evidence-based and culturally and linguistically appropriate health information; the role of language or communication barriers and culture in accessing care and communicating with providers; and preferences for care plan elements and format.
AHRQ-funded; HS019001.
Citation: Wen KY, Hu A, Ma GX .
Information and communication needs of Chinese American breast cancer patients: perspectives on survivorship care planning.
J Community Support Oncol 2014 Dec;12(12):439-45. doi: 10.12788/jcso.0095..
Keywords: Cancer: Breast Cancer, Cultural Competence, Clinician-Patient Communication, Racial and Ethnic Minorities