Pay now or pay later: providing interpreter services in health care.
(41/428)
Research amply documents that language barriers impede access to health care, compromise quality of care, and increase the risk of adverse health outcomes among patients with limited English proficiency. Federal civil rights policy obligates health care providers to supply language services, but wide gaps persist because insurers typically do not pay for interpreters, among other reasons. Health care financing policies should reinforce existing medical research and legal policies: Payers, including Medicaid, Medicare, and private insurers, should develop mechanisms to pay for interpretation services for patients who speak limited English. (+info)
Validation of the Beck Depression Inventory for a Portuguese-speaking Chinese community in Brazil.
(42/428)
The objective of the present study was to investigate the psychometric properties and cross-cultural validity of the Beck Depression Inventory (BDI) among ethnic Chinese living in the city of Sao Paulo, Brazil. The study was conducted on 208 community individuals. Reliability and discriminant analysis were used to test the psychometric properties and validity of the BDI. Principal component analysis was performed to assess the BDI's factor structure for the total sample and by gender. The mean BDI score was lower (6.74, SD = 5.98) than observed in Western counterparts and showed no gender difference, good internal consistency (Cronbach's alpha 0.82), and high discrimination of depressive symptoms (75-100%). Factor analysis extracted two factors for the total sample and each gender: cognitive-affective dimension and somatic dimension. We conclude that depressive symptoms can be reliably assessed by the BDI in the Brazilian Chinese population, with a validity comparable to that for international studies. Indeed, cultural and measurement biases might have influenced the response of Chinese subjects. (+info)
Factor structure of the Hospital Anxiety and Depression Scale (HADS) in German coronary heart disease patients.
(43/428)
BACKGROUND: Depression and anxiety in patients with coronary heart disease (CHD) are associated with a poorer prognosis. Therefore the screening for psychological distress is strongly recommended in cardiac rehabilitation. The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool that has demonstrated good sensitivity and specificity for mental disorders. METHODS: We assessed mental distress in in-patient cardiac rehabilitation in Germany. The factor structure of the German language version of the HADS was investigated in 1320 patients with CHD. Exploratory factor analysis and confirmatory factor analysis were used to determine the underlying factor structure of the instrument. RESULTS: Three-factor models were found to offer a superior fit to the data compared to two-factor (anxiety and depression) models. The German language HADS performs similarly to the English language version of the instrument in CHD patients. The German language HADS fundamentally comprises a tri-dimensional underlying factor structure (labelled by Friedman et al. as psychomotor agitation, psychic anxiety and depression). CONCLUSION: Despite of clinical usefulness in screening for mental disturbances the construct validity of the HADS is not clear. The resulting scores of the tri-dimensional model can be interpreted as psychomotor agitation, psychic anxiety, and depression in individual patient data or clinical investigations. (+info)
Cultural adaptation and validation of the "Kidney Disease and Quality of Life--Short Form (KDQOL-SF 1.3)" in Brazil.
(44/428)
The objective of the present study was to translate the Kidney Disease Quality of Life -- Short Form (KDQOL-SF 1.3) questionnaire into Portuguese to adapt it culturally and validate it for the Brazilian population. The KDQOL-SF was translated into Portuguese and back-translated twice into English. Patient difficulties in understanding the questionnaire were evaluated by a panel of experts and solved. Measurement properties such as reliability and validity were determined by applying the questionnaire to 94 end-stage renal disease patients on chronic dialysis. The Nottingham Health Profile Questionnaire, the Karnofsky Performance Scale and the Kidney Disease Questionnaire were administered to test validity. Some activities included in the original instrument were considered to be incompatible with the activities usually performed by the Brazilian population and were replaced. The mean scores for the 19 components of the KDQOL-SF questionnaire in Portuguese ranged from 22 to 91. The components "Social support" and "Dialysis staff encouragement" had the highest scores (86.7 and 90.8, respectively). The test-retest reliability and the inter-observer reliability of the instrument were evaluated by the intraclass correlation coefficient. The coefficients for both reliability tests were statistically significant for all scales of the KDQOL-SF (P < 0.001), ranging from 0.492 to 0.936 for test-retest reliability and from 0.337 to 0.994 for inter-observer reliability. The Cronbach's alpha coefficient was higher than 0.80 for most of components. The Portuguese version of the KDQOL-SF questionnaire proved to be valid and reliable for the evaluation of quality of life of Brazilian patients with end-stage renal disease on chronic dialysis. (+info)
Translation into Brazilian Portuguese, cultural adaptation and evaluation of the reliability of the Disabilities of the Arm, Shoulder and Hand Questionnaire.
(45/428)
The objective of the present study was to translate, adapt and validate a Brazilian Portuguese version of the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire. The study was carried out in two steps. The first was to translate the DASH into Portuguese and to perform cultural adaptation and the second involved the determination of the reliability and validity of the DASH for the Brazilian population. For this purpose, 65 rheumatoid arthritis patients of either sex (according to the classification criteria of the American College of Rheumatology), ranging in age from 18 to 60 years and presenting no other diseases involving the upper limbs, were interviewed. The patients were selected consecutively at the rheumatology outpatient clinic of UNIFESP. The following results were obtained: in the first step (translation and cultural adaptation), all patients answered the questions. In the second step, Spearman's correlation coefficients for interobserver evaluation ranged from 0.762 to 0.995, values considered to be highly reliable. In addition, intraclass correlation coefficients ranged from 0.97 to 0.99, also highly reliable values. Spearman's correlation coefficients and the intraclass correlation coefficients obtained during intra-observer evaluation ranged from 0.731 to 0.937 and from 0.90 to 0.96, respectively, being highly reliable values. The Ritchie Index showed a weak correlation with Brazilian DASH scores, while the visual analog scale of pain showed a good correlation with DASH score. We conclude that the Portuguese version of the DASH is a reliable instrument. (+info)
Improving patient-provider communication: insights from interpreters.
(46/428)
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 cross-cultural adaptation to Portuguese of the Trauma History Questionnaire to identify traumatic experiences.
(47/428)
BACKGROUND: Despite the high prevalence of exposure to traumatic events in Brazil, there are few studies on trauma and post-traumatic stress disorder. This paper presents the cross-cultural adaptation to Portuguese of the Trauma History Questionnaire. METHODS: Two translations and their respective back-translations were made, as well as the evaluation of the semantic equivalence, the preparation of the synthesis version, the pre-testing in the target population and the definition of the final version. DISCUSSION: Similar levels of referential meaning between the two back-translations and the original instrument were observed. Priority was given to the first translation in the decision process for the elaboration of the synthesis version. The pre-testing of this version in the target population confirmed the goal to achieve the semantic and the operational equivalence criteria. This work offers the first adaptation of a specific instrument to detect traumatic experiences in the Brazilian context. (+info)
Validation of the Social Phobia and Anxiety Inventory for Children (SPAI-C) in a sample of Brazilian children.
(48/428)
The purpose of the present study was to examine the factor structure and psychometric properties of the Social Phobia and Anxiety Inventory for Children (SPAI-C), an instrument developed in the United States and applied to a sample of Brazilian schoolchildren. The process included the translation of the original material from English into Portuguese by two bilingual psychiatrists and a back translation by a bilingual physician. Both the front and back translations were revised by a bilingual child psychiatrist. The study was performed using a cross-sectional design and the Portuguese version of the SPAI-C was applied to a sample of 1954 children enrolled in 3rd to 8th grade attending 2 private and 11 public schools. Eighty-one subjects were excluded due to an incomplete questionnaire and 2 children refused to participate. The final sample consisted of 1871 children, 938 girls (50.1%) and 933 boys (49.8%), ranging in age from 9 to 14 years. The majority of the students were Caucasian (89.0%) and the remainder were African-Brazilian (11.0%). The Pearson product-moment correlation showed that the two-week test-retest reliability coefficient was r = 0.780 and Cronbach's alpha was 0.946. The factor structure was almost similar to that reported in previous studies. The results regarding the internal consistency, the test-retest reliability and the factor structure were similar to the findings obtained in studies performed on English speaking children. The present study showed that the Portuguese language version of SPAI-C is a reliable and valid measure of social anxiety for Brazilian children. (+info)