Sharing stories: complex intervention for diabetes education in minority ethnic groups who do not speak English.
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OBJECTIVE: To develop and refine a complex intervention for diabetes support and education in minority ethnic groups, delivered through bilingual health advocates. DESIGN: Action research framework-a variety of methods used in an emergent and developmental manner, in partnership with clinicians, managers, and service users, drawing especially but not exclusively on narrative methods. SETTING: Deprived inner London district. INTERVENTIONS: Development and evaluation of three components of the complex intervention: a group based learning set for bilingual health advocates, in which stories about clients with diabetes formed the basis for action learning; advocate led support and education groups for people with diabetes, which used personal stories as the raw material for learning and action; organisational support to help to develop these new models and embed them within existing services. RESULTS: Both advocate groups and user groups were popular and well evaluated. Through storytelling, advocates identified and met their own educational needs in relation to diabetes and the unmet needs of service users. In the advocate led user groups, story fragments were exchanged in a seemingly chaotic way that the research team initially found difficult to facilitate or follow. Stories were not so much told as enacted and were often centred on discussion of "what to do." Whereas some organisations welcomed, successfully implemented, and sustained the advocate led groups, others failed to do so. A key component of the complex intervention was organisational support. CONCLUSIONS: An action research approach allowed engagement with an underserved group of health service staff and with hard to reach service users. The study produced subjective benefits to these groups locally as well as a worked-up complex intervention that will now be formally tested in a randomised controlled trial. (+info)
Improving patient-provider communication: insights from interpreters.
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BACKGROUND: It is important for physicians to recognize and address potential cross-cultural communication barriers with their patients. Several studies have demonstrated the importance of trained medical interpreters for ensuring effective patient-provider communication. Medical interpreters also represent an untapped source of insight into common communication problems. Such insights can contribute to strengthening physicians' cross cultural communication skills. OBJECTIVE: The purpose of this study was to explore professional medical interpreters' experiences and perspectives regarding patient-provider communication difficulties. METHODS: Key informant interviews were conducted with a purposive sample of nine professional interpreters working at the Geneva University Hospitals general medicine outpatient clinic. RESULTS: Interpreters described three domains where physicians and patients were likely to differ, and where mutual lack of awareness of those differences could lead to misunderstandings. These were: (1) ideas about the patient's health problem; (2) expectations of the clinical encounter; and (3) verbal and non-verbal communication styles. Interpreters recommended that cultural competence training for physicians focus on raising awareness about potential sources of misunderstanding and about the difficulties inherent in medical translation; providing basic background knowledge of patients' countries of origin; and adapting to patients' communication styles. While physicians' own perceptions of communication difficulties are important for developing learner-centered training activities, interpreters' bilingual and bicultural position allows for the identification of communication barriers that may be difficult for physicians to recognize. (+info)
The emergence of competing modules in bilingualism.
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How does the brain manage to store and process multiple languages without encountering massive interference and transfer? Unless we believe that bilinguals live in two totally unconnected cognitive worlds, we would expect far more transfer than actually occurs. However, imaging and lesion studies have not provided consistent evidence for the strict neuronal separation predicted by the theory of modularity. We suggest that emergentist theory offers a promising alternative. It emphasizes the competitive interplay between multiple languages during childhood and by focusing on the dual action of competition and entrenchment, avoids the need to invoke a critical period to account for age of acquisition effects in second-language learning. This view instantiates the motto formulated by Elizabeth Bates that 'modules are made, not born.' (+info)
Explanations, explanations, explanations: how do patients with limited English construct narrative accounts in multi-lingual, multi-ethnic settings, and how can GPs interpret them?
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BACKGROUND: The gap is widening between understanding the subtle ways patients and GPs manage their talk, and superficial discussion of the 'language barrier' among linguistic minority patients. All patients have to explain themselves, not just those for whom English is their first or main language. Patients' explanations reflect how they want the doctor to perceive them as a patient and as a person: they reveal patients' identities. Yet interpretations are not easy when patients' style of talking English is influenced by their first language and cultural background. OBJECTIVE: To explore in detail how patients with limited English and GPs jointly overcome misunderstandings in explanations. METHODS: Using discourse analysis and conversation analysis, we examine how GPs and their patients with limited English negotiate explanations and collaborate to manage, repair or prevent understanding problems. RESULTS: 31% of patients said English was not their first language. Misunderstandings arise owing to a range of linguistic and cultural factors, including stress and intonation patterns, vocabulary, the way a patient sequences their narrative, and patient and GP pursuing different agendas. CONCLUSION: When talk itself is the problem, patients' explanations can lead to misunderstandings, which GPs have to repair if they cannot prevent. Careful interpretation by skillful GPs can reveal patients' knowledge, experience and perspective. (+info)
Neighbour-nets portray the Chinese dialect continuum and the linguistic legacy of China's demic history.
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As with species studied by evolutionary biologists, languages are evolving entities. They can evolve in tree-like patterns, possibly blurred by borrowing, but they can also develop in non-tree-like schemes. For instance, diglossia, as in the case of Chinese, can counterbalance the hierarchical pattern expected from differentiation by internal change associated with isolation by distance of speech communities. Using two lexical datasets, either the basic lexicon supposedly more immune to borrowing or a representative sample of the whole lexicon, we investigate the development pattern of Chinese dialects using a neighbour-net approach, which is an unprejudiced technique for representing object relationships. The resulting graphs are consistent with a dialect continuum shaped by counterbalanced effects of homogenizing diglossia and borrowing versus differentiating spread of speech communities. Historical events and linguistic claims can be mapped on these graphs. (+info)
Limited english proficiency, primary language at home, and disparities in children's health care: how language barriers are measured matters.
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BACKGROUND: Approximately 3.5 million U.S. schoolchildren are limited in English proficiency (LEP). Disparities in children's health and health care are associated with both LEP and speaking a language other than English at home, but prior research has not examined which of these two measures of language barriers is most useful in examining health care disparities. OBJECTIVES: Our objectives were to compare primary language spoken at home vs. parental LEP and their associations with health status, access to care, and use of health services in children. METHODS: We surveyed parents at urban community sites in Boston, asking 74 questions on children's health status, access to health care, and use of health services. RESULTS: Some 98% of the 1,100 participating children and families were of non-white race/ethnicity, 72% of parents were LEP, and 13 different primary languages were spoken at home. "Dose-response" relationships were observed between parental English proficiency and several child and parental sociodemographic features, including children's insurance coverage, parental educational attainment, citizenship and employment, and family income. Similar "dose-response" relationships were noted between the primary language spoken at home and many but not all of the same sociodemographic features. In multivariate analyses, LEP parents were associated with triple the odds of a child having fair/poor health status, double the odds of the child spending at least one day in bed for illness in the past year, and significantly greater odds of children not being brought in for needed medical care for six of nine access barriers to care. None of these findings were observed in analyses of the primary language spoken at home. Individual parental LEP categories were associated with different risks of adverse health status and outcomes. CONCLUSIONS: Parental LEP is superior to the primary language spoken at home as a measure of the impact of language barriers on children's health and health care. Individual parental LEP categories are associated with different risks of adverse outcomes in children's health and health care. Consistent data collection on parental English proficiency and referral of LEP parents to English classes by pediatric providers have the potential to contribute toward reduction and elimination of health care disparities for children of LEP parents. (+info)
Limited English proficiency and breast and cervical cancer screening in a multiethnic population.
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OBJECTIVES: We examined the relationship between ability to speak English and receipt of Papanicolaou tests, clinical breast examinations, and mammography in a multiethnic group of women in the United States. METHODS: We used longitudinal data from the Study of Women Across the Nation to examine receipt of breast and cervical cancer screening among Chinese, Japanese, Hispanic, and White women who reported reading and speaking (1) only a language other than English, (2) another language more fluently than English, or (3) only English or another language and English with equal fluency. Logistic regression was used to analyze the data. RESULTS: Reading and speaking only a language other than English and reading and speaking another language more fluently than English, were significantly and negatively associated with receipt of breast and cervical cancer screening in unadjusted models. Although these findings were attenuated in adjusted models, not speaking English well or at all remained negatively associated with receipt of cancer screening. CONCLUSIONS: These findings suggest that language barriers contribute to health disparities by impeding adequate health communication. (+info)
Condition-dependent functional connectivity: syntax networks in bilinguals.
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This paper introduces a method to study the variation of brain functional connectivity networks with respect to experimental conditions in fMRI data. It is related to the psychophysiological interaction technique introduced by Friston et al. and extends to networks of correlation modulation (CM networks). Extended networks containing several dozens of nodes are determined in which the links correspond to consistent correlation modulation across subjects. In addition, we assess inter-subject variability and determine networks in which the condition-dependent functional interactions can be explained by a subject-dependent variable. We applied the technique to data from a study on syntactical production in bilinguals and analysed functional interactions differentially across tasks (word reading or sentence production) and across languages. We find an extended network of consistent functional interaction modulation across tasks, whereas the network comparing languages shows fewer links. Interestingly, there is evidence for a specific network in which the differences in functional interaction across subjects can be explained by differences in the subjects' syntactical proficiency. Specifically, we find that regions, including ones that have previously been shown to be involved in syntax and in language production, such as the left inferior frontal gyrus, putamen, insula, precentral gyrus, as well as the supplementary motor area, are more functionally linked during sentence production in the second, compared with the first, language in syntactically more proficient bilinguals than in syntactically less proficient ones. Our approach extends conventional activation analyses to the notion of networks, emphasizing functional interactions between regions independently of whether or not they are activated. On the one hand, it gives rise to testable hypotheses and allows an interpretation of the results in terms of the previous literature, and on the other hand, it provides a basis for studying the structure of functional interactions as a whole, and hence represents a further step towards the notion of large-scale networks in functional imaging. (+info)