ABSTRACT
CONTEXT: One central consideration in health professions education (HPE) is to ensure we are making sound and justifiable decisions based on the assessment instruments we use on health professionals. To achieve this goal, HPE assessment researchers have drawn on Kane's argument-based framework to ascertain the validity of their assessment tools. However, the original four-inference model proposed by Kane - frequently used in HPE validation research - has its limitations in terms of what each inference entails and what claims and sources of backing are housed in each inference. The under-specification in the four-inference model has led to inconsistent practices in HPE validation research, posing challenges for (i) researchers who want to evaluate the validity of different HPE assessment tools and/or (ii) researchers who are new to test validation and need to establish a coherent understanding of argument-based validation. METHODS: To address these identified concerns, this article introduces the expanded seven-inference argument-based validation framework that is established practice in the field of language testing and assessment (LTA). We explicate (i) why LTA researchers experienced the need to further specify the original four Kanean inferences; (ii) how LTA validation research defines each of their seven inferences and (iii) what claims, assumptions and sources of backing are associated with each inference. Sampling six representative validation studies in HPE, we demonstrate why an expanded model and a shared disciplinary validation framework can facilitate the examination of the validity evidence in diverse HPE validation contexts. CONCLUSIONS: We invite HPE validation researchers to experiment with the seven-inference argument-based framework from LTA to evaluate its usefulness to HPE. We also call for greater interdisciplinary dialogue between HPE and LTA since both disciplines share many fundamental concerns about language use, communication skills, assessment practices and validity in assessment instruments.
ABSTRACT
BACKGROUND: Low-participation of culturally and linguistically diverse (CALD) patients in medical research remains a problem in migrant and refugee destination countries such as Australia. The aims of this study were to explore i) CALD persons' perceptions and experiences of the medical system and medical research, in this case, older Italian Australians; and ii) the views of research professionals on CALD patient participation in medical research. DESIGN AND METHODS: A qualitative study was conducted in Melbourne, Australia, in 2015 utilising in-depth interviews and focus groups with four stakeholder groups: older Italian Australians (n=21); adult children of older Italian Australians (n=10); hospital Human Research Ethics Committee administrators (n=4); and clinical researchers (n=4). The data were analysed for content and thematic analysis. RESULTS: Themes for the CALD and family group were getting by in medical interactions; receptivity to medical research: testing the waters; and, receptivity to technology for support: passive versus active. Themes for the researcher and HREC groups about CALD patient participation in research were: exclusion; cultural factors; and e-consent. CONCLUSIONS: Our findings from four stakeholder perspectives and experiences confirm that there were considerable cultural, linguistic, and resourcing barriers hindering the participation of older Italian-Australians in medical research. Furthermore, our findings showed that in this study setting there were few enabling strategies in place to address these barriers despite the national ethics guidelines for equitable participation in research. The findings informed the creation of a multimedia tool whose purpose is to address and improve representation of CALD groups in clinical research. Significance for public healthMany people from culturally and linguistically diverse (CALD) backgrounds remain excluded from medical research such as clinical trials due to a range of language and cultural factors that can be amplified when this population is ageing. This exclusion has implications for the ability of CALD populations to benefit from participating in medical research and for applying research findings to CALD populations. It is essential to develop and implement strategies to include CALD communities in medical research and to uphold the ethical obligation of obtaining informed consent to research. The findings of this study have guided the development of a tablet-based resource which can be used in clinical and community contexts to raise awareness about the purpose of medical research. The resource has been carefully designed to be appropriate for participants' cultural background as well as their preferred language and literacy level. Such a resource has potential to address some of the cultural and linguistic barriers to clinical trial participation of CALD populations.
ABSTRACT
The under-representation of culturally and linguistically diverse participants in clinical trials is an ongoing concern for medical researchers and the community. The aim of this review is to examine the complex issue of recruiting culturally and linguistically diverse (CALD) older people to medical research and to examine responses to these issues. The review focuses on (1) trends in the existing literature on barriers to and strategies for recruiting CALD and older people to clinical research, (2) issues with informed consent for CALD populations, and (3) the efficacy of innovative approaches, including approaches incorporating multimedia in research and consent processes. The literature indicates that predominant barriers to greater involvement of CALD patients in clinical trials are communication, including literacy and health literacy considerations; English language competence; and cultural factors in the research setting such as mistrust of consent processes, as well as considerable practical and logistical barriers, including mobility considerations. Some evidence exists that incorporating multimedia resources into the informed consent process can improve patient understanding and is preferred by patients, yet these findings are inconclusive. A multi-methodological approach, including the use of culturally and linguistically sensitive multimedia tools, may help address the issue of low inclusion of CALD groups in clinical research. Researcher education needs to be taken into account to address preconceptions about CALD resistance to research participation and to raise awareness of cultural concerns in regard to research participation.
