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AHRQ Research Studies Date
Topics
- Access to Care (2)
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- Cancer: Colorectal Cancer (1)
- Children/Adolescents (1)
- Clinician-Patient Communication (2)
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- COVID-19 (1)
- (-) Cultural Competence (15)
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- Patient and Family Engagement (1)
- Primary Care (4)
- Provider (1)
- Racial and Ethnic Minorities (7)
- Screening (1)
- Shared Decision Making (1)
- Substance Abuse (1)
- Telehealth (1)
- Vulnerable Populations (1)
- Women (3)
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 15 of 15 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
Salinas KE, Bazan M, Rivera L
Experiences and communication preferences in pregnancy care among patients with a Spanish language preference: a qualitative study.
The purpose of this study was to explore Spanish-speaking patients' experiences and preferences regarding communication during pregnancy care with specific attention to language barriers. The researchers conducted focus groups with patients with a Spanish language preference who gave birth between July 2022 and February 2023 at an academic medical center. A total of seven focus groups with 27 total participants were held. The study identified three key themes regarding preferences in patient experiences and communication when seeking pregnancy care: 1. language discordance and concordance between patients and clinicians exist on a spectrum and are not binary; 2. language-discordant care presents communication challenges, even when interpreters are present; and 3. language discordance can be effectively addressed with positive interpersonal engagements between clinicians and patients.
AHRQ-funded; HS026370.
Citation: Salinas KE, Bazan M, Rivera L .
Experiences and communication preferences in pregnancy care among patients with a Spanish language preference: a qualitative study.
Obstet Gynecol 2023 Nov 1; 142(5):1227-36. doi: 10.1097/aog.0000000000005369..
Keywords: Maternal Care, Women, Communication, Cultural Competence, Racial and Ethnic Minorities
Truong S, Foley OW, Fallah P
Transcending language barriers in obstetrics and gynecology: a critical dimension for health equity.
This article discusses the issue of language barriers in obstetrics and gynecology. The authors present two cases of language-discordant care and a framework for addressing language as a critical lens for health inequities in obstetrics and gynecology, which includes a variety of clinical settings such as labor and delivery, perioperative care, outpatient clinics, and inpatient services, as well as sensitivity around reproductive health topics. Drivers of language-related inequities at the clinician, health system, and societal level are explored in the proposed framework. They end with actionable recommendations for enhancing equitable care for patients experiencing language barriers.
AHRQ-funded; HS026370.
Citation: Truong S, Foley OW, Fallah P .
Transcending language barriers in obstetrics and gynecology: a critical dimension for health equity.
Obstet Gynecol 2023 Oct 1; 142(4):809-17. doi: 10.1097/aog.0000000000005334..
Keywords: Cultural Competence, Women, Maternal Care, Disparities
Ramirez M, Duran MC, Penfold RB
STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia.
This paper describes what is needed to adapt the STAR-Caregivers Virtual Training and Follow-up (STAR-VTF), an evidence-based intervention that teaches family caregivers how to manage behavioral and psychological symptoms of dementia to Latino caregivers. This qualitative research study interviewed Spanish- and English-speaking caregivers of people with dementia who self-identify as Hispanic/Latino (N = 30) and healthcare and social service providers of older Latino clients and/or Latino family caregivers (N = 14). The authors identified three themes: (i) there was a need to increase awareness about dementia and decrease stigma; (ii) semantics mattered as certain words and phrases could be stigmatizing, offensive, or culturally inappropriate; and (iii) there was a need to incorporate into program materials the traditional family structure and nature of caregiving in Latino families. Based on findings, STAR-VTF was adapted to expand content to improve understanding of dementia, language was revised that was viewed as problematic, and cultural examples were added to reflect the range of family involvement in caring for people living with dementia and multigenerational living.
AHRQ-funded; HS026369.
Citation: Ramirez M, Duran MC, Penfold RB .
STAR-Caregivers Virtual Training and Follow-up: a cultural adaptation for Latino caregivers of people with dementia.
Transl Behav Med 2023 Sep 12; 13(9):625-34. doi: 10.1093/tbm/ibad028..
Keywords: Education: Patient and Caregiver, Cultural Competence, Racial and Ethnic Minorities, Dementia, Neurological Disorders
Loo S, Brady KJS, Ragavan MI
Validation of the Clinicians' Cultural Sensitivity Survey for use in pediatric primary care settings.
This study examined the validity of the Clinicians’ Cultural Sensitivity Survey (CCCS) for use in pediatric primary care, which was developed as a patient-reported survey assessing clinicians' recognition of cultural factors affecting care quality for older Latino patients. The authors adapted the survey for use with parents of pediatric patients. A convenience sampling approach was used to identify eligible parents during well-child visits at urban pediatric primary care clinic, and parents were administered the survey via electronic tablet. They first conducted exploratory factor analyses (EFAs) to explore the dimensionality of survey responses in the adapted CCSS, and then conducted a series of confirmatory factor analyses (CFAs) using maximum likelihood estimation based on the results of the EFAs. Exploratory and confirmatory factor analyses (N = 212 parent surveys) supported a three-factor structure assessing racial discrimination, culturally-affirming practices, and causal attribution of health problems. The 3-factor model also outperformed other potential factors in terms of fit statistics and demonstrated adequate fit.
AHRQ-funded; HS022242; HS026395.
Citation: Loo S, Brady KJS, Ragavan MI .
Validation of the Clinicians' Cultural Sensitivity Survey for use in pediatric primary care settings.
J Immigr Minor Health 2023 Aug; 25(4):790-802. doi: 10.1007/s10903-023-01469-2..
Keywords: Children/Adolescents, Primary Care, Cultural Competence, Healthcare Delivery
Weiner SG, Lo YC, Carroll AD
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
The objective of this study was to evaluate the presence of stigmatizing language in clinical notes related to patients with substance use disorders and to detect patient- and provider-level differences. Results showed that the majority of patients with substance-related diagnoses had at least one note containing stigmatizing language. There were also several patient characteristic disparities associated with patients who had stigmatizing language in their notes. The author concluded that more clinician interventions about use of stigmatizing language are needed.
AHRQ-funded; HS026753.
Citation: Weiner SG, Lo YC, Carroll AD .
The incidence and disparities in use of stigmatizing language in clinical notes for patients with substance use disorder.
J Addict Med 2023 Jul-Aug; 17(4):424-30. doi: 10.1097/adm.0000000000001145..
Keywords: Disparities, Cultural Competence, Substance Abuse, Behavioral Health, Racial and Ethnic Minorities
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
Castaneda-Guarderas A, Glassbereg J, Grudzen CR
Shared decision making with vulnerable populations in the emergency department.
The authors introduce a research agenda that includes community-engaged approaches, mixed-methods studies, and cost-effectiveness analyses to address questions of shared decision making (SDM) among vulnerable groups at a disadvantage in the healthcare system, as well as changes that are needed, and how to cultivate and teach these competencies.
AHRQ-funded; HS024172.
Citation: Castaneda-Guarderas A, Glassbereg J, Grudzen CR .
Shared decision making with vulnerable populations in the emergency department.
Acad Emerg Med 2016 Dec;23(12):1410-16. doi: 10.1111/acem.13134.
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Keywords: Cultural Competence, Shared Decision Making, Emergency Department, Patient and Family Engagement, Vulnerable Populations
Martens CE, Crutchfield TM, Laping JL
Why wait until our community gets cancer?: Exploring CRC screening barriers and facilitators in the Spanish-speaking community in North Carolina.
The objectives for this paper were: (1) to improve understanding of preferences regarding potential colorectal cancer (CRC) screening program characteristics, and (2) to improve understanding of the barriers and facilitators around CRC screening with the Hispanic, immigrant community in North Carolina. They found that Hispanics may have a general awareness of and interest in CRC screening, but multiple barriers prevent them from getting screened, and recommended that special attention be given to designing culturally and linguistically appropriate programs to improve access to healthcare resources, insurance, and associated costs among Hispanics.
AHRQ-funded; HS019468.
Citation: Martens CE, Crutchfield TM, Laping JL .
Why wait until our community gets cancer?: Exploring CRC screening barriers and facilitators in the Spanish-speaking community in North Carolina.
J Cancer Educ 2016 Dec;31(4):652-59. doi: 10.1007/s13187-015-0890-4.
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Keywords: Cancer: Colorectal Cancer, Cultural Competence, Racial and Ethnic Minorities, Racial and Ethnic Minorities, Screening
Yun K, Paul P, Subedi P
Help-seeking behavior and health care navigation by Bhutanese refugees.
The objective of this study was to document barriers to care, help-seeking behaviors, and the impact of a community-based patient navigation intervention on patient activation levels among Bhutanese refugees in the U.S. Following the intervention, only one-third reported the lowest level of patient activation and one-third were highly activated. Bhutanese refugees overcome healthcare access barriers by seeking help from a network of support that begins within the community.
AHRQ-funded; HS021706.
Citation: Yun K, Paul P, Subedi P .
Help-seeking behavior and health care navigation by Bhutanese refugees.
J Community Health 2016 Jun;41(3):526-34. doi: 10.1007/s10900-015-0126-x.
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Keywords: Access to Care, Cultural Competence, Education: Patient and Caregiver, Health Literacy, Racial and Ethnic Minorities
Rosas LG, Lv N, Xiao L
Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): a randomized controlled trial.
The authors discussed the 5-year Vida Sana study, which tests a culturally adapted and technology-enhanced group-based Diabetes Prevention Program intervention in a randomized controlled trial with overweight/obese Latino adults who have metabolic syndrome and/or pre-diabetes. The main goal was to determine the effectiveness of the intervention. The authors hypothesized that the intervention will lead to a greater mean reduction in weight at 24 months vs. usual care.
AHRQ-funded; HS022702.
Citation: Rosas LG, Lv N, Xiao L .
Evaluation of a culturally-adapted lifestyle intervention to treat elevated cardiometabolic risk of Latino adults in primary care (Vida Sana): a randomized controlled trial.
Contemp Clin Trials 2016 May;48:30-40. doi: 10.1016/j.cct.2016.03.003.
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Keywords: Cultural Competence, Lifestyle Changes, Racial and Ethnic Minorities, Primary Care, Racial and Ethnic Minorities
Bishop WP, Craddock Lee SJ, Skinner CS
Validity of single-item screening for limited health literacy in English and Spanish speakers.
The researchers evaluated 3 single-item screening measures for limited health literacy in a community-based population of English and Spanish speakers. They found that for English speakers, no difference was seen among the items. For Spanish speakers, "ability to read" identified inadequate literacy better than "help reading hospital materials."
AHRQ-funded; HS022418.
Citation: Bishop WP, Craddock Lee SJ, Skinner CS .
Validity of single-item screening for limited health literacy in English and Spanish speakers.
Am J Public Health 2016 May;106(5):889-92. doi: 10.2105/ajph.2016.303092.
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Keywords: Cultural Competence, Education: Patient and Caregiver, Health Literacy
Tucker CM, Wall WA, Wippold G
Development of an inventory for health-care office staff to self-assess their patient-centered cultural sensitivity.
The researchers sought to determine the psychometric properties of the Tucker-Culturally Sensitive Health Care Office Staff Inventory-Self-Assessment Form (T-CSHCOSI-SAF). They found that this inventory has 2 factors with high internal consistency reliability. They concluded that the T-CSHCOSI-SAF is a useful inventory for health-care office staff to assess their own level of patient-centered cultural sensitivity and that it can be used in the development and implementation of trainings to promote patient-centered cultural sensitivity of health-care office staff.
AHRQ-funded; HS013151; HS010726.
Citation: Tucker CM, Wall WA, Wippold G .
Development of an inventory for health-care office staff to self-assess their patient-centered cultural sensitivity.
Health Serv Res Manag Epidemiol 2016 Apr 27;3. doi: 10.1177/2333392816629600.
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Keywords: Healthcare Delivery, Cultural Competence, Patient-Centered Healthcare, Primary Care, Provider
Li J, Maxwell AE, Glenn BA
Healthcare access and utilization among Korean Americans: The mediating role of English use and proficiency.
This study examines whether English language use and proficiency plays a mediating role in the relationships between length of hospital stay in the US and health insurance coverage, access to, and use of care. Results show that health care utilization was primarily driven by having health insurance and a usual source of care. Recommendations include a focus on increasing English use and proficiency and insurance coverage among older, female, less educated Korean Americans to mitigate health disparities associated with reduced access to health services in this population.
AHRQ-funded; HS000046.
Citation: Li J, Maxwell AE, Glenn BA .
Healthcare access and utilization among Korean Americans: The mediating role of English use and proficiency.
Int J Soc Sci Res 2016 Mar;4(1):83-97. doi: 10.5296/ijssr.v4i1.8678.
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Keywords: Access to Care, Cultural Competence, Disparities, Healthcare Utilization, Racial and Ethnic Minorities
Howard J, Etz RS, Crocker JB
Maximizing the patient-centered medical home (PCMH) by choosing words wisely.
The authors described new terminology that some innovative primary care practices are using to support the transformational culture of the PCMH. Using data from the AHRQ-funded Working Conference for PCMH Innovation 2013, they found that language innovations were used by 5 of the 10 convened practices and that participants felt that the language used was important for reinforcing substantive changes. They concluded that new terminology must represent values to which practices genuinely aspire.
AHRQ-funded; HS021287.
Citation: Howard J, Etz RS, Crocker JB .
Maximizing the patient-centered medical home (PCMH) by choosing words wisely.
J Am Board Fam Med 2016 Mar-Apr;29(2):248-53. doi: 10.3122/jabfm.2016.02.150199.
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Keywords: Cultural Competence, Patient-Centered Healthcare, Primary Care, Organizational Change