Can ChatGPT rescue or assist with language barriers in healthcare communication?

This letter supplements some ideas put forward by Kim et al., who debated the importance of patient-centered communication as a central notion of patient-centered cancer care in pre- versus post-pandemic times, although the issue of language barriers by select patients at healthcare centers was not debated. This letter proposes large language models, such as ChatGPT, as one way to overcome the language barrier with non-native English-speaking patients, as well as to simplify the technical language and jargon to make communication of the medical conditions or treatment options easier for those patients to understand. The latter may even be helpful for native English-speaking patients.

Barriers to Electronic Patient-Reported Outcome Measurement Among Patients with Cancer and Limited English Proficiency.

Importance: Often electronic tools are built with English proficient (EP) patients in mind. Cancer patients with limited English proficiency (LEP) experience gaps in care and are at risk for excess toxic effects if they are unable to effectively communicate with their care team. Objective: To evaluate whether electronic patient-reported outcome tools (ePROs) built to improve health outcomes for EP patients might also be acceptable for LEP patients in the context of oral cancer-directed therapies (OCDT). Design, Setting, and Participants: This qualitative study was conducted at a single National Cancer Institute-designated comprehensive cancer center. In 2019, English-speaking and Spanish-speaking LEP patients with cancer receiving oral chemotherapies were recruited to participate in a qualitative focus group examining patient attitudes toward ePROs and electronic tools that are used to manage adherence and symptoms related to oral therapies. Six focus groups were held for EP patients and 1 for Spanish-speaking LEP patients. LEP was defined as patients who self-identified as needing an interpreter to navigate the health care system. Data analysis was performed April through June of 2019. Exposures: Enrolled patients participated in a focus group lasting approximately 90 minutes. Main Outcomes and Measures: The perspectives of patients with cancer treated with oral chemotherapies on integrating ePROs into their care management. Results: Among the 46 participants included in the study, 46 (100%) were White, 10 (22%) were Latinx Spanish-speaking, 43 (93%) were female, and 37 (80%) were aged at least 50 years or older. Among the 6 focus groups with 6 to 8 EP patients (ranging from 6 to 8 participants) and 1 focus group with 10 Spanish-speaking LEP patients, this qualitative study found that EP and LEP patients had different levels of acceptability of using technology and ePRO tools to manage their OCDT. EP patients felt generally positive toward OCDT and were not generally interested in using electronic tools to manage their care. LEP patients generally disliked OCDT and welcomed the use of technology for health management, particularly when addressing gaps in symptom management by their oncology clinicians. Conclusions and Relevance: Although most electronic interventions target EP patients, these findings reveal the willingness of LEP patients to participate in technology-based interventions. Expanding ePROs to LEP patients may help to manage gaps in communication about treatment and potential adverse events because of the willingness of LEP patients to use ePRO tools to manage their health. This qualitative assessment is a strategic step in determining the resources needed to narrow the digital health gap and extend the value of PROs to the LEP oncology population.

Limited English proficiency in the labor and delivery unit.

PURPOSE OF REVIEW: Limited English proficiency (LEP) impacts patient access to safe and comprehensive care during the antepartum, intrapartum, and postpartum periods. In this review, we explore disparities in care delivery and outcomes that LEP women experience, and discuss the importance of providing language concordant care and using interpretation services appropriately. RECENT FINDINGS: The number of individuals with LEP is steadily increasing in the United States. Pregnant women with LEP suffer disparities in obstetric care and are at risk for postpartum depression, breastfeeding difficulties, and substandard newborn care after neonatal ICU discharge because of insufficient education. Addressing these issues requires the implementation of language concordant care and education, along with the utilization of medically trained interpreters. Although further evidence is needed, the authors support these interventions to improve patient satisfaction, decrease medical errors, and curtail misdiagnoses. SUMMARY: The pregnant woman with limited English proficiency is at risk of receiving suboptimal care and experiencing negative outcomes during the antepartum, intrapartum, and postpartum periods. The use of medically trained interpreters and the provision of language concordant care, through workforce diversification and the creation of forms and educational materials in diverse languages, can improve patient safety, outcomes, and quality of care.

Sexual issues in people with haemophilia: Awareness and strategies for overcoming communication barriers.

INTRODUCTION: The Haemophilia Experiences, Results and Opportunities (HERO) Study identified sexual health as an important psychosocial issue affecting people with haemophilia (PWH) worldwide. However, sexual health is inadequately addressed at haemophilia treatment centres (HTCs), because PWH and healthcare professionals (HCPs) experience barriers to broaching the subject. There is a clear need for HCP training to support communication in this area and improve comprehensive care. AIM: The Sexual Health: Strategies for Effective Communication pilot programme was trialled in Canada to assess HCP readiness and ability to discuss sexual health issues with PWH and test communication tools to facilitate these conversations. METHODS: The pilot programme consisted of two 3-h sessions attended by seven HCPs from Calgary's Alberta Children's and Foothills Hospitals. The sessions included lectures and case scenarios and explained the check-in-affirm-clarify-answer and head-heart-body tools designed by the Centre for Sexuality to aid communication. The pilot was evaluated through discussions and an online questionnaire. RESULTS: The pilot was well received by all HCP participants. Questionnaire data showed improvements in participants' knowledge, skills and comfort level in conducting sexual health discussions. Greatest improvements were noted in knowledge (100% 'good' or 'excellent' after the pilot, compared with 29% beforehand). Importantly, 86% felt that the material presented would be applicable in clinical practice. CONCLUSION: The Canadian pilot demonstrated the effectiveness of the proposed educational programme. The underlying principles could be adapted to similar programmes for other HTCs to facilitate sexual health discussions.

Preventing Home Medication Administration Errors.

Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy-informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.

Project20: interpreter services for pregnant women with social risk factors in England: what works, for whom, in what circumstances, and how?

BACKGROUND: Black and minority ethnic women and those with social risk factors such as deprivation, refugee and asylum seeker status, homelessness, mental health issues and domestic violence are at a disproportionate risk of poor birth outcomes. Language barriers further exacerbate this risk, with women struggling to access, engage with maternity services and communicate concerns to healthcare professionals. To address the language barrier, many UK maternity services offer telephone interpreter services. This study explores whether or not women with social risk factors find these interpreter services acceptable, accessible and safe, and to suggest solutions to address challenges. METHODS: Realist methodology was used to refine previously constructed programme theories about how women with language barriers access and experience interpreter services during their maternity care. Twenty-one longitudinal interviews were undertaken during pregnancy and the postnatal period with eight non-English speaking women and their family members. Interviews were analysed using thematic framework analysis to confirm, refute or refine the programme theories and identify specific contexts, mechanisms and outcomes relating to interpreter services. RESULTS: Women with language barriers described difficulties accessing maternity services, a lack of choice of interpreter, suspicion around the level of confidentiality interpreter services provide, and questioned how well professional interpreters were able to interpret what they were trying to relay to the healthcare professional during appointments. This resulted in many women preferring to use a known and trusted family member or friend to interpret for them where possible. Their insights provide detailed insight into how poor-quality interpreter services impact on their ability to disclose risk factors and communicate concerns effectively with their healthcare providers. A refined programme theory puts forward mechanisms to improve their experiences and safety such as regulated, high-quality interpreter services throughout their maternity care, in which women have choice, trust and confidence. CONCLUSIONS: The findings of this study contribute to concerns highlighted in previous literature around interpreter services in the wider healthcare arena, particularly around the lack of regulation and access to high-quality interpretation. This is thought to have a significant effect on pregnant women who are living socially complex lives as they are not able to communicate their concerns and access support. This not only impacts on their safety and pregnancy outcomes, but also their wider holistic needs. The refined program theory developed in this study offers insights into the mechanisms of equitable access to appropriate interpreter services for pregnant women with language barriers.

Interpreter Use for Limited English Proficiency Patients/Families: A QI Study.

BACKGROUND: Communication is fundamental to high-quality health care. Despite federal requirements to provide interpreters and growing evidence favoring the benefits of interpreter use, providers' use of interpreters remains suboptimal. In acute care settings, where decisions need to be made rapidly on the basis of changing clinical circumstances, this has proven to be challenging. METHODS: We designed a quality improvement project using the model for improvement methodology for patients admitted to the pediatric hospital medicine service. A multidisciplinary team developed interventions focused on provider education and leveraging health information technology (IT). We used health IT to improve the identification of families with limited English proficiency, improve access to various modalities of interpreting, standardize workflow to request face-to-face (F2F) interpreters, and create a designated place in the electronic health record for interpreter use documentation. The use of all forms (telephone, video, and F2F) of interpreter service, documentation of interpreter uses, and F2F interpreter overload were tracked monthly for 3 years. RESULTS: The baseline use of interpreter services for the pediatric hospital medicine inpatient service was 64%. After starting the project, the use of interpreter service increased to 97% and has sustained for more than a year since the project's completion. The use of F2F interpreters also increased from a baseline of 20% to 54% post intervention. CONCLUSIONS: We successfully achieved and sustained our goals of improving interpreter use through supportive leadership and a multidisciplinary approach using quality improvement methodology. Future efforts should be focused on defining and standardizing metrics for families with limited English proficiency across institutions and using health IT to improve care.

Variações linguísticas e seus efeitos na saúde:: reflexões para a clínica fonoaudiológica / Linguistic variations and their effects on health:: reflections for the speech therapy clinic / Variaciones lingüísticas y sus efectos sobre la salud:: reflexiones para la clínica de logopedia

Introdução: As variações linguísticas não correspondem a distúrbios de comunicação, entretanto a sua valoração, constitui fonte de preconceito linguístico e discriminação social, chegando a processos de "patologização". Falantes de variações linguísticas não prestigiadas, supondo algum distúrbio, procuraram o serviço de saúde com queixa de sofrer discriminação por preconceito linguístico. Experimentavam sensação de inferioridade, retraimento social, até rebaixamento da autoestima; levando a crises de ansiedade ou a episódios depressivos. Objetivo: Analisar as repercussões das variações linguísticas em um grupo de sujeitos, estabelecer indicações à reflexão sobre essa problemática no campo da saúde, especialmente no manejo dessas repercussões no âmbito da clínica fonoaudiológica. Método: Estudo de natureza descritiva, caracterizado, em seu desenho, como estudo de caso. Utilizou-se a metodologia do Grupo de Discussão, que consiste em favorecer e promover a construção de discurso grupal; sendo este o objeto da pesquisa. Resultados e Discussão: As variações linguísticas são constituídas em função de origem, extração sociocultural e condição socioeconômica e foram percebidas como variável significativa da discriminação e exclusão social. As categorias analíticas depreendidas do discurso grupal: preconceito e bullying; comunidade de fala e exclusão social; expectativas frente à norma prestigiada. O trabalho fonoaudiológico deverá: - reconhecer e valorizar o sofrimento das vítimas; - promover o trânsito pelas variações linguísticas, entender nuances fonético-fonológicas, sintáticas, semânticas e prosódicas, avaliando os usos e contextos sociais dos gêneros discursivos orais. Conclusão: Indicar à Fonoaudiologia para acolher e atender as vítimas de preconceito linguístico, no âmbito da ação clínica de prevenção de agravos e de promoção da saúde.

Introduction:  Linguistic variations do not correspond to communication disorders; however, their valuation constitutes a source of linguistic prejudice and social discrimination, reaching processes of "pathologization". Speakers of non-prestigious linguistic variations, assuming some speech disorder, sought the health service with a complaint of suffering discrimination due to linguistic prejudice. They experienced a sensation of inferiority, social withdrawal, even lowering of self-esteem; leading to bouts of anxiety or depressive episodes. Objective: To analyze the repercussions of linguistic variations in a group of people, establish indications for reflection on this problem in the field of health, especially in the management of these repercussions in the field of speech therapy. Methods: 'Descriptive Research' characterized, in it's design, as a case study. The 'Focus Group Discussion' methodology was used, which consists in favoring and promoting the construction of a group discourse; this being the object of the research. Results: The linguistic variations are constituted in function of origin, socio-cultural extraction and socioeconomic condition and were perceived as a significant variable of discrimination and social exclusion. The analytical categories inferred from the focus group: prejudice and bullying; the speech community and social exclusion; expectations in relation to the prestigious norm. The Speech therapy work should: - recognize and value the suffering of victims; - promote the transit through linguistic variations, understanding phonetic-phonological, syntactic, semantic and prosodic nuances, evaluating the uses and social contexts of oral discourse genders. Conclusion: To indicate the Speech therapy to welcome and assist the victims of linguistic prejudice, in the scope of the clinical action of prevention and health promotion.

Introduccion: Las variaciones lingüísticas no corresponden a los trastornos de la comunicación, sin embargo su valoración es fuente de prejuicios lingüísticos y de discriminación social, lo que conduce a procesos de "patologización". Los hablantes de variaciones lingüísticas no prestigiosas, asumiendo algún trastorno del habla, buscaron el servicio de salud quejándose de discriminación por prejuicios lingüísticos. Experimentaban una sensación de inferioridad, de retraimiento social, incluso de disminución de la autoestima; lo que provocaba crisis de ansiedad o episodios depresivos. Objetivo: Analizar las repercusiones de las variaciones lingüísticas en un grupo de sujetos, establecer indicaciones para la reflexión sobre este problema en el campo de la salud, especialmente en el manejo de estas repercusiones en el campo de la logopedia. Metodos:  Un 'Estudio Descriptivo', caracterizado en su diseño como un estudio de caso. Se utilizó la metodología del 'Grupo de Discusión', que consiste en favorecer y promover la construcción de un discurso grupal, siendo éste el objeto de la investigación. Resultados: Las variaciones lingüísticas se constituyen en función del origen, la extracción sociocultural y la condición socioeconómica y se perciben como una variable significativa de discriminación y exclusión social. Las categorías analíticas deducidas del discurso de grupo: prejuicios e intimidación; la comunidad de discurso y la exclusión social; expectativas en relación con la norma de prestigio. El trabajo logopedista debería: - reconocer y valorar el sufrimiento de las víctimas; - promover el tránsito por las variaciones lingüísticas, comprendiendo los matices fonético-fonológicos, sintácticos, semánticos y prosódicos, evaluando los usos y contextos sociales de los géneros del discurso oral. Conclusión: Indicar a Logopedia que acoja y asista a las víctimas de los prejuicios lingüísticos, en el ámbito de la acción clínica de prevención y promoción de la salud.

From "stuck" to satisfied: Aboriginal people's experience of culturally safe care with interpreters in a Northern Territory hospital.

BACKGROUND: Globally, interpreters are underused by health providers in hospitals, despite 40 years of evidence documenting benefits to both patients and providers. At Royal Darwin Hospital, in Australia's Northern Territory, 60-90% of patients are Aboriginal, and 60% speak an Aboriginal language, but only approximately 17% access an interpreter. Recognising this system failure, the NT Aboriginal Interpreter Service and Royal Darwin Hospital piloted a new model with interpreters embedded in a renal team during medical ward rounds for 4 weeks in 2019. METHODS: This research was embedded in a larger Participatory Action Research study examining cultural safety and communication at Royal Darwin Hospital. Six Aboriginal language speaking patients (five Yolŋu and one Tiwi), three non-Indigenous doctors and five Aboriginal interpreter staff were purposefully sampled. Data sources included participant interviews conducted in either the patient's language or English, researcher field notes from shadowing doctors, doctors' reflective journals, interpreter job logs and patient language lists. Inductive narrative analysis, guided by critical theory and Aboriginal knowledges, was conducted. RESULTS: The hospital experience of Yolŋu and Tiwi participants was transformed through consistent access to interpreters who enabled patients to express their clinical and non-clinical needs. Aboriginal language-speaking patients experienced a transformation to culturally safe care. After initially reporting feeling "stuck" and disempowered when forced to communicate in English, participants reported feeling satisfied with their care and empowered by consistent access to the trusted interpreters, who shared their culture and worldviews. Interpreters also enabled providers to listen to concerns and priorities expressed by patients, which resulted in holistic care to address social determinants of health. This improved patient trajectories and reduced self-discharge rates. CONCLUSIONS: A culturally unsafe system which restricted people's ability to receive equitable healthcare in their first language was overturned by embedding interpreters in a renal medical team. This research is the first to demonstrate the importance of consistent interpreter use for providing culturally safe care for Aboriginal patients in Australia.

Influência dos métodos de ensino pecs e teacch sobre o desenvolvimento neuropsicomotor de crianças com transtorno do espectro autista / Influence of pecs and teacch teaching methods on the neuropsychomotor development of children with autistic spectrum disorder / Influencia de pecs y métodos de enseñanza teacch en el desarrollo neuropsicomotor de niños con trastorno del espectro autista

Introdução: Os transtornos do espectro autista caracterizam-se como distúrbios relacionados ao neurodesenvolvimento, que são considerados transtornos do desenvolvimento neurológico, e, usualmente, manifestam-se na primeira infância. Objetivos: Identificar a influência de métodos alternativos no desenvolvimento neuropsicomotor de crianças com Transtorno do Espectro Autista (TEA). Métodos: Estudo analítico, observacional, longitudinal, retrospectivo com 23 crianças com TEA de dois a quinze anos de idade. Os dados foram colhidos a partir de visitas ao projeto "Corujas do Bem", na cidade de Catanduva-SP, e aplicação de questionários aos profissionais e pais das crianças. Após a sistematização das informações e divisão em dois grupos, sendo um verbal e outro não verbal, os resultados foram discutidos junto à literatura atual. Resultados: Apesar de todas as mães notarem diferenças nos filhos, a melhora global, de acordo com as suas pedagogas, não foi linear. O grupo de alunos verbais se destacou em cinco dos preditores analisados (socialização, capacidade de seguir ordens, estereotipias, controle de esfíncteres e coordenação motora fina) enquanto o grupo de não verbais em quatro (comportamento inadequado, coordenação motora grossa, concentração e agitação). Conclusão: Embora não haja diferença significativa de melhora entre os alunos verbais e não verbais, as crianças do projeto, como um todo, apresentaram uma melhora na evolução quanto ao desenvolvimento global com o uso dos métodos TEACCH e PECS associados à atuação de uma equipe multidisciplinar.(AU)

Introduction: Autism spectrum disorders are characterized as neurodevelopmental disorders, which are considered neurological developmental disorders, and usually manifest in early childhood. Objectives: To identify the influence of alternative methods on the neuropsychomotor development of children with Autistic Spectrum Disorder (ASD). Methods: Analytical, observational, longitudinal, retrospective study with 23 children with ASD from two to fifteen years of age. The data were collected from visits to the project "Corujas do Bem", in the city of Catanduva-SP, and the application of questionnaires to professionals and parents of children. After the systematization of information and division into two groups, one verbal and the other non-verbal, the results were discussed together with the current literature. Results: Although all mothers noticed differences in their children, the overall improvement, according to their educators, was not linear. The group of verbal students stood out in five of the predictors analyzed (socialization, ability to follow orders, stereotypes, sphincter control and fine motor coordination) while the group of non-verbal in four (inappropriate behavior, coarse motor coordination, concentration and agitation). Conclusion: Although there is no significant improvement difference between verbal and nonverbal students, the children of the project, as a whole, presented an improvement in the evolution regarding the global development with the use of TEACCH and PECS methods associated with the performance of a multidisciplinary team.

Introducción: Los trastornos del espectro autista se caracterizan por ser trastornos relacionados con el neurodesarrollo, que se consideran trastornos del neurodesarrollo y suelen manifestarse en la primera infancia. Objetivos: Identificar la influencia de métodos alternativos en el desarrollo neuropsicomotor de niños con Trastorno del Espectro Autista (TEA). Métodos: Estudio analítico, observacional, longitudinal, retrospectivo con 23 niños con TEA de dos a quince años de edad. Los datos fueron recolectados de las visitas al proyecto "Corujas do Bem", en la ciudad de Catanduva-SP, y la aplicación de cuestionarios a los profesionales y padres de los niños. Luego de sistematizar la información y dividirla en dos grupos, uno verbal y otro no verbal, se discutieron los resultados con la literatura actual. Resultados: Aunque todas las madres notaron diferencias en sus hijos, la...(AU)

Barriers to and enablers of attendance at diabetic retinopathy screening experienced by immigrants to Canada from multiple cultural and linguistic minority groups.

AIM: To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. METHODS: Using a patient-oriented research approach leveraging Diabetes Action Canada's patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. RESULTS: We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one's country of birth for screening, the impact of winter, and preferences for alternative medicine. CONCLUSION: Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.

The Association of Spanish Language Preference with Advance Directive Completion.

BACKGROUND/OBJECTIVES: Hispanics have lower advance directive (AD) completion than non-Hispanic Whites. Few studies have assessed the role of language preference in end-of-life planning. We investigated whether language preference and needing an interpreter affected AD completion among older adults in an integrated health system. DESIGN: Retrospective cohort investigation of electronic medical records. SETTING: Northern California integrated health system. PARTICIPANTS: A total of 620,948 Hispanic and non-Hispanic White patients, aged 55 years and older, between January 1, 2013, and December 31, 2017. MEASUREMENTS: Descriptive statistics and bivariate analysis were performed to compare AD completion among non-Hispanic Whites, Hispanics, and Hispanic subgroups by language preference (English speaking, Spanish speaking, and needed interpreter). We conducted multivariable logistic regression to determine the relationship between language preference and having an AD while controlling for demographic, clinical, and utilization factors. RESULTS: We found 20.3% of non-Hispanic Whites (n = 512,577) and 10.9% of Hispanics (n = 108,371) had completed an AD. Among Hispanics, after controlling for demographic, clinical, and utilization factors, compared with Spanish speakers requiring an interpreter, English speakers had nearly two-fold increased odds of completing an AD (adjusted odds ratio (aOR) = 2.6; 95% confidence interval (CI) = 2.4-2.9), whereas Spanish speakers not requiring an interpreter had 20% increased odds (aOR = 1.2; 95% CI = 1.1-1.3). Additional predictors of successful AD completion were being female, being older, having more comorbidities, having more hospital and emergency department visits, and having higher socioeconomic status. There were no differences associated with primary care provider characteristics. CONCLUSION: These findings indicate the need for a tailored outreach to Hispanics, particularly among those subgroups who require the need of an interpreter, to reduce AD completion disparities.

Supportive psychological intervention on psychological disorders in clinical medicine students with English Learning Difficulties: A protocol of systematic review.

BACKGROUND: This study aims to examine the effect of supportive psychological intervention (SPI) on psychological disorders (PD) in clinical medicine students (CMS) with English Learning Difficulties (ELD). METHODS: We will perform a comprehensive literature search from the following databases: Cochrane Library, MEDLINE, EMBASE, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All databases will be performed from their inception to the present without language limitation by 2 independent reviewers. We will also look for grey literature, such as conference proceedings, dissertations or theses. Newcastle-Ottawa Scale will be used to assess study quality, and RevMan 5.3 software will be applied to carry out statistical analysis. RESULTS: This study will summarize the most recent evidence to assess the effect of SPI on PD in CMS with ELD. CONCLUSION: This study may provide helpful evidence of SPI on PD in CMS with ELD. OSF REGISTRATION NUMBER:: osf.io/tah2s.

Insights on Spiritual Care for the Deaf Community.

Communicating effectively with persons who have a hearing disability can be challenging; assessing and providing spiritual care for these individuals is a more formidable expectation. Understanding the culture includes knowing available communication strategies and how best to use sign language interpreters. Building trust, demonstrating respect, and honoring privacy are essential components for nurses who wish to offer spiritual care. Utilizing spiritual caring moments as well as Helen Keller's example of successful communication across the hearing-nonhearing divide gives nurses valuable insights.

Midwives experiences of caring for immigrant women at antenatal care.

OBJECTIVE: The aim of this study was to describe Swedish midwives' experiences of caring for immigrant women at antenatal care clinics. METHODS: Five group interviews and one individual interview were conducted with 16 midwives working in the maternity care. The interviews were transcribed and analysed with latent content analysis. RESULTS: Three main categories emerged: 1) Be able to convey and receive information. Communication was influenced by the women's educational level and previous experiences. The interpreter's competence was of great importance, but also if the midwife was able to create a trusting relationship with the woman. 2) Experience other cultures. The midwife's duties and responsibilities differed from the woman's expectations of the visit. The woman's family was of great importance and influential. 3) Midwife's role and work situation. Midwives' working conditions were challenged and they developed strategies to cope with this; however, they desired support and time for reflection and processing. CONCLUSION: Communication difficulties were cultural and linguistic in nature, and required extra care. This can be achieved if the midwife has time, but also support in managing cultural differences. In the future, new communication tools and ways of communicating must be developed.

Barriers to Accessing and Negotiating Mental Health Services in Asylum Seeking and Refugee Populations: The Application of the Candidacy Framework.

This review brought together research investigating barriers asylum seekers and refugees (AS&R) face in accessing and negotiating mental health (MH) services. The candidacy framework (CF) was used as synthesizing argument to conceptualize barriers to services (Dixon-Woods et al. in BMC Med Res Methodol 6:35, 2006). Five databases were systematically searched. Twenty-three studies were included and analyzed using the CF. The seven stages of the framework were differentiated into two broader processes-access and negotiation of services. Comparatively more data was available on barriers to access than negotiation of services. The Identification of Candidacy (access) and Appearances at Services (negotiation) were the most widely discussed stages in terms of barriers to MH care. The stage that was least discussed was Adjudications (negotiation). The CF is useful to understand inter-related barriers to MH care experienced by AS&R. A holistic approach is needed to overcome these barriers together with further research investigating understudied areas of candidacy.

Issues in internet-based support for chinese-american breast cancer survivors.

Objective: The incidence of breast cancer in Chinese-Americans is increasing. This article aims to present and discuss the challenges encountered in implementing an Internet-based coaching/support program for Chinese-American breast cancer survivors and to provide direction for future Internet-based interventions targeting this specific population.Methods: The data were collected from (a) interventionists' diaries written during individual coaching/support sessions with survivors, (b) minutes taken during research meetings, and (c) written records of issues discussed during the interventions. The data were analyzed using content analysis.Results: The issues were categorized into eight themes. The following six themes were identified among the survivors: (1) low computer literacy, (2) ambivalent attitudes towards study participation (e.g., joining the project to maintain a harmonious relationship with the gatekeepers versus lack of trust in the project), (3) reticence to share opinions and experiences, (4) struggles with family affairs (e.g., intergenerational cultural dissonance), (5) overvaluing Traditional Chinese Medicine, and (6) specific participants' preferences (e.g., language, font size, timing). Among the interventionists, the following two themes were identified: (1) recruitment and retention of interventionists and (2) language barriers.Conclusions: Culture-specific challenges need to be considered when designing and implementing an Internet-based coaching/support program for Chinese-American breast cancer survivors.

Implementing innovative evidence-based perinatal mental health screening for women of refugee background.

PROBLEM: National guidelines recommend repeated screening for depression and anxiety for all women in the perinatal period. Routine screening in pregnancy is limited due to service, community and individual barriers. BACKGROUND: Perinatal depression and perinatal anxiety affect up to 20% of all women. Women of refugee background are at even greater risk for perinatal mental health conditions due to refugee experiences and resettlement stressors. AIM: To evaluate the acceptability and feasibility of a perinatal mental health screening program for women of refugee background from the perspective of health professionals. METHODS: A mixed methods design guided by the Normalization Process Theory was used. Data were collected at a dedicated refugee antenatal clinic in the south-eastern suburbs of Melbourne, Australia. An online survey (n=38), focus groups (n=2; 13 participants) and semi-structured interviews (n=8; 11 participants) with health professionals were conducted. FINDINGS: Under the four constructs of the Normalization Process Theory, health professionals reported improvements in identifying and referring women with mental health issues, more open and in-depth conversations with women about mental health and valued using an evidenced-based measure. Key issues included professional development, language barriers and time constraints. DISCUSSION: Implementing a perinatal mental health screening program has been positively received. Strategies for sustainability include professional development and the addition of audio versions of the measures. CONCLUSION: This perinatal mental health screening program is acceptable and a feasible option for health professionals. Health professionals value providing more holistic care and have more open discussion with women about mental health.

Evidence for an integrated healthcare and psychosocial multidisciplinary model to address rough sleeping.

People who sleep rough/experience unsheltered homelessness face barriers accessing mainstream healthcare and psychosocial services. The barriers to service access exacerbate poor health, which in turn create additional challenges for rough sleepers to access health and psychosocial services, including stable housing. The study presents descriptive statistics to identify housing outcomes of people working with a Multidisciplinary Model that comprises integrated healthcare and psychosocial support, and qualitative data with clients and service providers to investigate how the Model is experienced and delivered in practice. Fieldwork was conducted between December 2016 and March 2018 with the Multidisciplinary Team operating in Cairns, in the far north of Australia. Qualitative data are drawn from in-depth interviews with 26 rough sleepers and 33 health and psychosocial service providers from the Multidisciplinary Team and the wider service system. Descriptive statistics show that 67% of clients who were sleeping rough were supported to immediately access stable housing, and at the end of the program, all clients remained housed. The qualitative findings illustrated how integrated healthcare and psychosocial outreach enabled people sleeping rough to overcome barriers they experienced accessing mainstream healthcare and other services. With the benefit of healthcare, people felt sufficiently well to engage with the psychosocial service providers to have their housing and other psychosocial needs addressed. This article demonstrates how individual responsibility for and control over healthcare is not only a matter of the individual, but also a matter requiring systems change and the active provision of resources to cater for the constraints and opportunities present in people's immediate environments.

Transition experiences of internationally qualified midwives practising midwifery in Australia.

BACKGROUND: Internationally qualified midwives comprise approximately 13% of the Australian midwifery workforce. Despite their central role in the Australian midwifery system, understanding of their transitional experiences is limited. AIM: To explore the transitional experiences of internationally qualified midwives practising in Australia. METHOD: A descriptive qualitative study was undertaken, as the second phase of a larger mixed methods study. In this paper we present in-depth insights from 11 internationally qualified midwives practising in Australia. Individual semi-structured interviews were conducted between May-August 2018, digitally recorded and then transcribed. Transcriptions were analysed using a thematic analysis approach. FINDINGS: Participants in this study identified that the different culture of the work environment, differences in midwifery practice, lack of autonomy in their practice and perceived discrimination influenced their transition into Australian midwifery practice. Four themes were identified: 'Differences in midwifery practice', 'Cultural incongruence', 'Discrimination' and 'Mixed emotions'. DISCUSSION: Success during the complex transition process depends on the migrant midwives' ability to build a sense of belonging, and to develop and adopt strategies that assist in dealing with new workplaces and an unfamiliar workforce. CONCLUSION: A structured transition program prior to commencing practice, as well as an evidence-based workplace mentorship program with a focus on Australian midwifery care and culture, may be effective strategies to facilitate their transition. To promote awareness of multiculturalism within the work environment, this study recommends actively encouraging host staff to further develop perspectives that enable them to create positive relationships with staff from other cultures.