The impact of bilinguality and language context on the understanding of epistemic adverbs in health communication: the case of English and Russian.

Aim: To explore how English epistemic adverbs, as used in health communication, are understood by speakers depending on their first language (L1) and language context. Methods: We used an online dissimilarity rating task with paired doctors' opinions which differed only with respect to the embedded epistemic adverbs (e.g., This treatment definitely has side effects vs. This treatment possibly has side effects). In order to evaluate the possible effect of one's L1, we compared the ratings of English-speaking monolinguals and Russian-English bilinguals in Australia (Study 1). To evaluate the impact of language context, we compared the ratings of Russian-English bilinguals in Australia and Russia (Study 2). The data were interpreted using classical multidimensional scaling (C-MDS) analysis, complemented by cultural consensus analysis and hierarchical cluster analysis. Results: The C-MDS analyses returned statistically acceptable results. Intragroup consensus was evident for all speaker groups. They all clustered the high confidence adverbs (clearly, definitely, and obviously) and the hearsay adverbs (presumably and supposedly) similarly. Effects of L1 were seen: for example, unlike the monolinguals, the Russian bilinguals did not include evidently with the high confidence adverbs (Study 1). An effect of context was also evident: Russian-English bilinguals in Australia most resembled the monolinguals in their understanding of epistemic adverbs. The way Russian-based bilinguals clustered epistemic adverbs reflected a less nuanced understanding (Study 2). Conclusion: The subtle differences in how adverbs of likelihood and doubt are understood in health communication suggest extra care is needed when conveying risk and uncertainty to patients from diverse linguistic and/or cultural backgrounds to ensure mutual understanding and mitigate against miscommunication. The impact of L1 and language context on one's understanding highlights the need to explore more widely how epistemic adverbs are understood by diverse populations and, in doing so, improve healthcare communication practices.

Clinician Perspectives of Communication with Aboriginal and Torres Strait Islanders Managing Pain: Needs and Preferences.

Poor communication is an important factor contributing to health disparity. This study sought to investigate clinicians' perspectives about communicating with Aboriginal and Torres Strait Islander patients with pain. This multi-site and mixed-methods study involved clinicians from three pain management services in Queensland, Australia. Clinicians completed a survey and participated in focus groups. Clinicians rated the importance of communication training, their knowledge, ability, and confidence in communicating with Aboriginal and Torres Strait Islander patients using a 5-point Likert scale. Rating scores were combined into low (scores 1-2); moderate (score 3) and high (scores 4-5). Informed by an interpretive description methodology, thematic analysis of focus group data was used to identify the communication needs and training preferences of clinicians. Overall (N = 64), 88% of clinicians rated the importance of communication training when supporting Aboriginal and Torres Strait Islander patients as "high". In contrast, far fewer clinicians rated as "high" their knowledge (28%), ability (25%) and confidence (28%) in effectively communicating with Aboriginal and Torres Strait Islander patients. Thematic analysis identified three areas of need: knowledge of Aboriginal and Torres Strait Islander cultures, health beliefs, and understanding cross-cultural cues. Communication skills can be learned and training, in the form of a tailored intervention to support quality engagement with Aboriginal and Torres Strait Islander patients, should combine cultural and communication aspects with biomedical knowledge.

Comprehending Adverbs of Doubt and Certainty in Health Communication: A Multidimensional Scaling Approach.

This research explored the feasibility of using multidimensional scaling (MDS) analysis in novel combination with other techniques to study comprehension of epistemic adverbs expressing doubt and certainty (e.g., evidently, obviously, probably) as they relate to health communication in clinical settings. In Study 1, Australian English speakers performed a dissimilarity-rating task with sentence pairs containing the target stimuli, presented as "doctors' opinions." Ratings were analyzed using a combination of cultural consensus analysis (factor analysis across participants), weighted-data classical-MDS, and cluster analysis. Analyses revealed strong within-community consistency for a 3-dimensional semantic space solution that took into account individual differences, strong statistical acceptability of the MDS results in terms of stress and explained variance, and semantic configurations that were interpretable in terms of linguistic analyses of the target adverbs. The results confirmed the feasibility of using MDS in this context. Study 2 replicated the results with Canadian English speakers on the same task. Semantic analyses and stress decomposition analysis were performed on the Australian and Canadian data sets, revealing similarities and differences between the two groups. Overall, the results support using MDS to study comprehension of words critical for health communication, including in future studies, for example, second language speaking patients and/or practitioners. More broadly, the results indicate that the techniques described should be promising for comprehension studies in many communicative domains, in both clinical settings and beyond, and including those targeting other aspects of language and focusing on comparisons across different speech communities.

When and Why Threats Go Undetected: Impacts of Event Rate and Shift Length on Threat Detection Accuracy During Airport Baggage Screening.

OBJECTIVE: We aimed to assess the impact of task demands and individual characteristics on threat detection in baggage screeners. BACKGROUND: Airport security staff work under time constraints to ensure optimal threat detection. Understanding the impact of individual characteristics and task demands on performance is vital to ensure accurate threat detection. METHOD: We examined threat detection in baggage screeners as a function of event rate (i.e., number of bags per minute) and time on task across 4 months. We measured performance in terms of the accuracy of detection of Fictitious Threat Items (FTIs) randomly superimposed on X-ray images of real passenger bags. RESULTS: Analyses of the percentage of correct FTI identifications (hits) show that longer shifts with high baggage throughput result in worse threat detection. Importantly, these significant performance decrements emerge within the first 10 min of these busy screening shifts only. CONCLUSION: Longer shift lengths, especially when combined with high baggage throughput, increase the likelihood that threats go undetected. APPLICATION: Shorter shift rotations, although perhaps difficult to implement during busy screening periods, would ensure more consistently high vigilance in baggage screeners and, therefore, optimal threat detection and passenger safety.

Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language.

BACKGROUND: Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. METHODS/DESIGN: Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. DISCUSSION: Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.