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PubMed2005

Breaking the language barrier: machine assisted diagnosis using the medical speech translator.

In this paper, we describe and evaluate an Open Source medical speech translation system (MedSLT) intended for safety-critical applications. The aim of this system is to eliminate the language barriers in emergency situation. It translates spoken questions from English into French, Japanese and Finnish in three medical subdomains (headache, chest pain and abdominal pain), using a vocabulary of about 250-400 words per sub-domain. The architecture is a compromise between fixed-phrase translation on one hand and complex linguistically-based systems on the other. Recognition is guided by a Context Free Grammar Language Model compiled from a general unification grammar, automatically specialised for the domain. We present an evaluation of this initial prototype that shows the advantages of this grammar-based approach for this particular translation task in term of both reliability and use.

Communication Barriers↗
PubMedDate not supplied

Bridging language and cultural barriers between physicians and patients.

OBJECTIVE: This study explored a group of primary care physicians' use of various methods to bridge language and cultural barriers between themselves and their patients and the physicians' perceptions of the availability and quality of these methods. METHODS: The authors mailed a questionnaire to 495 primary care physicians in the Greater Bay Area of northern California, an area chosen for its ethnically diverse population. Respondents were asked to estimate how many patients they saw per week, how many encounters they had per week with non-English-speaking patients, and how often they used each of six interpretation methods. They were also asked to assess the availability and quality of interpretation services. RESULTS: Physicians reported that, on average, 21% of visits were with non-English-speaking patients. Trained medical interpreters or the AT&T Language Line were used, on average, in fewer than 6% of these encounters, and no interpreters were used in 11%. In 27% of encounters with non-English-speaking patients, the physician could speak the patient's language, in 20% interpretation was done by a staff member who had no formal interpretation training, and in 36% a family member or companion of the patient interpreted. Physicians who had access to trained interpreters reported a significantly higher quality of patient-physician communication than physicians who used other methods (P < 0.0001). CONCLUSIONS: In an area of great ethnic diversity where physicians who had access to the services of trained interpreters reported a significantly higher quality of patient-physician communication, the low rates of use of trained interpreters suggest that factors other than quality, such as costs, preclude greater use of these services.

Adolescent↗
PubMedDate not supplied

Hearing aid use in nursing homes. Part 2: Barriers to effective utilization of hearing AIDS.

OBJECTIVE: This study examined barriers to hearing aid use among persons who were reported to have a hearing aid and among those reported to have hearing difficulties but no hearing aids. SETTING: Interviews were conducted at a large, mid-Atlantic nonprofit nursing home. PARTICIPANTS: Both nursing home residents (279) and nursing staff members (51) were interviewed. DESIGN AND MEASUREMENTS: In a cross-sectional survey of nursing home residents, brief structured interviews were performed by trained research assistants with both residents and caregivers to obtain information regarding residents' hearing ability, hearing aid use and daily maintenance, and potential barriers to such use. RESULTS: Among residents reported to have hearing problems but who did not use a hearing aid, the major problem was neglect of the issue; participants did not know why residents did not have a hearing aid, residents had not had hearing evaluations, and staff members were not aware of hearing problems in residents. Among residents who did use a hearing aid, the majority (69%) of those for whom information was available had problems with the devices. The most common problems reported were that the device was hard or inconvenient to use, it did not fit well or hurt, and the device was not functioning well. The vast majority (86%) needed help taking care of the hearing aids. Close to half of the staff members had not received any training in the use or maintenance of the devices. Lack of delegation of responsibility for the management of hearing was identified for 29%, and relatives were used for maintenance of hearing aids in 14% of residents with hearing aids. CONCLUSIONS: Barriers to hearing aid use are therefore complex and multifactorial, involving lack of system commitment to utilization of hearing aids, lack of knowledge by staff members, inappropriate delegation and care procedures, hearing aid design and fit issues, and difficulties for residents in handling the hearing aids. Addressing these issues requires change on multiple levels, including change at the institutional level, concerning policy and training; change at the unit level, regarding care procedures and follow up; change at the individual level, providing better checks of fit and function of the hearing aids; and finally, change at the societal level, addressing design and cost issues for hearing aids in this population.

Activities of Daily Living↗
PubMed1996

Cultural barriers between obstetrician-gynecologists and Vietnamese/Chinese immigrant women.

In the latter part of the 20th century, Asian immigration has exploded. The two main groups, Chinese and Vietnamese, share many cultural views. Confucianism, Taoism, and spiritualism play an important role in the Chinese and Vietnamese psyches and influence deeply their beliefs of health, disease, birth, and death. Before the introduction of Western medicine, both countries relied heavily on the Taoist model of health and disease. That is, disease is disharmony in the body and herbal medicines are used to restore that balance. Since the introduction of Western medicine, the two countries have adopted a crisis-oriented system of care in which, except for vaccinations, preventive medicine is virtually ignored. The Confucian beliefs of privacy and female modesty have made the field of obstetrics and gynecology particularly susceptible to noncommunication and misunderstandings, while traditional beliefs in Taoist medicine may delay or interfere with Western health care.

Acculturation↗
PubMedDate not supplied

Providing culturally competent primary care for immigrant and refugee women. A Cambodian case study.

Currently, one of every 13 U.S. residents is foreign born. A 1991 survey of certified nurse-midwives (CNMs) indicated that 51% of the respondents serve immigrant women. Using a case study approach, this article illustrates barriers to health care experienced by foreign-born women and demonstrates how cultural competence increases provider effectiveness in meeting the unique needs of this population. Effective primary care requires understanding the context of the refugee experience and its physical and emotional sequelae; addressing geographic, linguistic, economic, and cultural barriers; and providing high-quality care through the efficient use of resources without unduly controlling women's choices. Providing care within the context of the traditional family structure, gender roles, family support systems, and community services and resources further enhances health care services. Equally important is the establishment of a sustained partnership with clients, based on the support of protective traditional health practices and the recognition that a woman is expert in her own health. By respecting the complex cultural, political, economic, and personal backgrounds that contribute to immigrant women's perceptions of health, illness, and health care needs, culturally competent primary care providers serve diverse populations more effectively and help to enrich the communities in which they live and work.

Adult↗
PubMed2004

Access to hepatitis B vaccination among Korean American children in immigrant families.

This study examined social determinants affecting successful completion of the hepatitis B vaccination protocol among Korean American children in immigrant families. The effects of family characteristics, social support from support network, barriers to immunizations, and health beliefs concerning hepatitis B vaccination were examined using logistic regression analysis. Information support concerning parenting and child health (adjusted odds ratio [aOR] 2.55, 95% confidence interval [CI] 1.11-7.02) and perception that hepatitis B was a difficult disease from which to recover (aOR 2.11, 95% CI 1.20-3.72) appear to be the most important factors for vaccination compliance after adjusting for family income, mother's education level, and health insurance coverage. The burden of paying for immunizations (aOR 0.50, 95% CI 0.22-0.90) also had an impact on the vaccination status. These findings suggest that identifying the children at risk of undervaccination against hepatitis B maybe aided by focusing on these social determinants in addition to provider and sociodemographic characteristics.

Asian↗
PubMed2004

Understanding the challenges in recruiting blacks to a longitudinal cohort study: the Adventist health study.

This paper presents findings from formative research exploring Black Seventh-day Adventist church members' attitudes about Black non-participation in past studies, and suggestions for recruiting 45,000 Blacks to an upcoming longitudinal cohort study. Data were collected in California and Pennsylvania, using 15 key informant interviews and 6 focus groups. Key findings supported and elucidated existing literature on the barriers to minority recruitment, and included: a general mistrust of the medical/scientific community; a perception that providing informed consent relinquishes, rather than protects, an individual's rights; a perception of being "studied" rather than "studying," due to the paucity of Black investigators; and a perceived lack of cultural sensitivity in the recruitment of Blacks, and in the conduct of the research itself. Building trust throughout the process, from clearly demonstrating the benefits of participation, at the individual and community level, to including Blacks in the study design from conceptualization to data analysis and presentation, emerged as a critical component in garnering Black participation in future studies.

Adult↗
PubMed2004

Women's approaches to the use of new technology for cancer risk information.

BACKGROUND: Women are currently offered multiple sources of breast cancer risk information, and the Internet is the most rapidly growing health information source. The objectives of this study were to identify women's preferences for receiving online breast cancer risk information, to identify barriers to accessing this information, and to identify differences in these factors between Internet users and non-users. METHODS: Eight focus groups were conducted with women aged 18 to 74 (n = 65) living in King County, Washington. RESULTS: Participants were interested in accessing online health information with the support of a real person to assist with information searches and in accessing personalized information online. Participants emphasized the importance of trust, both in the content provider and in the organization collecting their personal data. CONCLUSIONS: Web sites should provide personalized information and personal searching assistance. They should also include disclosures of content sources and a privacy policy that details how personal data is handled.

Adult↗
PubMed2001

Evidence-based medicine in general practice: beliefs and barriers among Australian GPs.

If implemented, evidence-based medicine (EBM) in general practice will improve health outcomes for patients. This paper examines the views of 60 Australian general practitioners about EBM. While 57% of respondents had a computer in their surgery, 15% had Internet access and only 3% had access to the Cochrane Library at work. The most commonly cited barrier to EBM was 'patient demand for treatment despite lack of evidence for effectiveness' (45%). The next three most highly rated barriers related to lack of time. For each of three tasks of EBM, namely searching for evidence, appraising evidence and discussing the implications of evidence with patients, lack of time was rated as a 'very important barrier' by significantly more participants than lack of skills (McNemar's tests: chi2(1) = 7.1, P = 0.008, chi2(1) = 14.0, P = 0.001 and chi2(1) = 9.0, P = 0.003, respectively). Preferred resources for EBM included clinical practice guidelines (rated as 'very useful' by 55%) and journals that summarize research evidence, for example Evidence-based Medicine (52%). Systematic reviews were considered 'very useful' by only 15% of respondents, consistent with our finding that 30% did not understand the term 'systematic review'. Furthermore, 43% did not understand 'meta-analysis'. A minority indicated they understood the terms 'relative risk' (23%), 'absolute risk' (28%) and 'number needed to treat' (15%) sufficiently to explain to others. Skills development is crucial to achieve EBM in general practice.

Adult↗
PubMed2003

Linguistic and cultural barriers to care.

CONTEXT: Primarily because of immigration, Asian Americans are one of the fastest growing and most ethnically diverse minority groups in the United States. However, little is known about their perspectives on health care quality. OBJECTIVE: To examine factors contributing to quality of care from the perspective of Chinese- and Vietnamese-American patients with limited English language skills. DESIGN: Qualitative study using focus groups and content analysis to determine domains of quality of care. SETTING: Four community health centers in Massachusetts. PARTICIPANTS: A total of 122 Chinese- and Vietnamese-American patients were interviewed in focus groups by bilingual interviewers using a standardized, translated moderator guide. MAIN OUTCOME MEASURES: Domains of quality of care mentioned by patients in verbatim transcripts. RESULTS: In addition to dimensions of health care quality commonly expressed by Caucasian, English-speaking patients in the United States, Chinese- and Vietnamese-American patients with limited English proficiency wanted to discuss the use of non-Western medical practices with their providers, but encountered significant barriers. They viewed providers' knowledge, inquiry, and nonjudgmental acceptance of traditional Asian medical beliefs and practices as part of quality care. Patients also considered the quality of interpreter services to be very important. They preferred using professional interpreters rather than family members, and preferred gender-concordant translators. Furthermore, they expressed the need for help in navigating health care systems and obtaining support services. CONCLUSIONS: Cultural and linguistically appropriate health care services may lead to improved health care quality for Asian-American patients who have limited English language skills. Important aspects of quality include providers' respect for traditional health beliefs and practices, access to professional interpreters, and assistance in obtaining social services.

Asian↗
PubMed1996

Improving the use of information in medical effectiveness research.

There is increased emphasis on improving the quality of health care by obtaining and disseminating information about the effectiveness and outcomes of care and by facilitating more consumer input participation in decision-making. We examine barriers to information use and the challenges that these barriers pose for effectiveness research. We divide our discussion into four goals of effectiveness research. These are: (1) to provide more information so that consumers, providers and policymakers can make "rational" decisions; (2) to incorporate patient preferences into health care decisions; (3) to develop guidelines that incorporate both individual perspectives and societal perspectives; (4) to use information to improve the practice of health care. We discuss four recommendations for improving the use of information: (1) the evidence on how people actually make decisions should be used to inform the design and implementation of effectiveness research; (2) decision-making should be structured through guidelines and policies; (3) criteria should be developed for determining which guidelines should fully incorporate patient preferences; (4) safeguards should be established to guard against misuse of information.

Communication Barriers↗
PubMedDate not supplied

Bringing safety and responsiveness into the forefront of care for pregnant and parenting aboriginal people.

Poor access to prenatal care for Aboriginal people is well documented, and is explicated as an unethical barrier to care resulting from colonial and neocolonial values, attitudes, and practices. A postcolonial standpoint, participatory research principles, and a case study design were used to investigate 2 Aboriginal organizations' experiences improving care for pregnant and parenting Aboriginal people. Data were collected through exploratory interviews and small-group discussions with purposefully selected community leaders, providers, and community members. The study found that safety in healthcare relationships and settings, and responsiveness to individuals' and families' unique experiences and capacities must be brought into the forefront of care. Results suggest that the intention of care must be situated within a broader view of colonizing relations to improve early access to, and relevance of, care during pregnancy and parenting for Aboriginal people.

Attitude of Health Personnel↗
PubMedDate not supplied

A community-based collaboration to assess and improve medical insurance status and access to health care of Latino children.

OBJECTIVES: Despite eligibility for subsidized insurance, low-income Latino children are at high risk of being medically uninsured. The authors sought to understand and improve access to medical insurance for Latino children living in a California community of predominantly low-income immigrant families. METHODS: During the summer of 1999, trained women from the community conducted interviews in Spanish with 252 randomly selected mothers of 464 children younger than age 19. Mothers provided information about family demographics, children's medical insurance, health care access, and experiences obtaining and maintaining children's insurance. RESULTS: Most children (83.3%) were eligible for subsidized medical insurance (48.4% Medi-Cal eligible; 35.0% Healthy Families eligible). Twenty-eight percent of eligible children were not enrolled. Non-enrolled eligible children were older (median age 7) than enrolled children (median age 4) and more likely to be born outside the U.S. (22.2%) than enrolled children (4.8%). Among children ages 3-18, those not enrolled were less likely to have visited a doctor in the past 12 months (58% compared to 78.7%) and less likely to have a usual source of care (96.3% compared to 99.5%). Mothers of non-enrolled children were more likely than mothers of enrolled children to have less than seven years of education (47.8% compared to 36.4%). Families with non-enrolled children were more likely to report out-of-pocket medical expenses (84.1% compared to 53%). Families with non-enrolled children were more likely to report barriers to the enrollment process, such as problems providing required documents (39.7% compared to 15.1%), problems understanding Spanish forms (19.4% compared to 8.9%), and confusing paperwork (39.7% compared to 24.7%). Most mothers (75.9%) reported that community organizations provided very useful help with children's insurance enrollment. Almost half (48.6%) preferred to receive enrollment assistance from community organizations. Only 43.3% of mothers had heard of the Healthy Families program. CONCLUSIONS: To reach the majority of uninsured Latino children, community-based outreach and insurance application assistance are crucial. Most important, the process of applying for and maintaining coverage in Medi-Cal or Healthy Families must be simplified.

Adolescent↗
PubMed1996

A survey of health agencies' responses to non-English-speaking women's health needs in south Australia.

Evidence from the literature points to the disadvantages encountered by migrant women from non-English-speaking backgrounds in obtaining access to health services. In May 1994, a survey of 31 health units in the metropolitan area and two country areas was conducted in South Australia. The study investigated the services available to women of non-English-speaking background, their level of usage, the factors that affected the use of health services by the women, and the strategies developed by the service providers to overcome the barriers. The study found sexual and reproductive health to be the most important, and occupational health and safety the least important issue for women of non-English-speaking background attending the state's health units. The main problems were English language deficiencies, lack of culturally appropriate services and inadequate knowledge and awareness of the existing services. From the service providers' point of view, language (79 per cent), culture (87 per cent), and information or awareness about health units (78 per cent) were the most important factors affecting the use of health services by women of non-English-speaking background. Women of non-English-speaking background have different linguistic and cultural needs from English-speaking women, and as a result, require specifically designed services.

Adolescent↗
PubMed2003

In the right words: addressing language and culture in providing health care.

As part of its continuing mission to serve trustees, executives, and staff of health foundations and corporate giving programs, Grantmakers In Health (GIH) convened a group of experts from philanthropy, research, health care practice, and policy on April 4, 2003, to discuss the roles of language and culture in providing effective health care. During this Issue Dialogue, In the Right Words: Addressing Language and Culture in Providing Health Care, health grantmakers and experts from policy and practice participated in an open exchange of ideas and perspectives on language access and heard from fellow grantmakers who are funding innovative programs in this area. Together they explored ways to effectively support comprehensive language services, including the use of interpreters and translation of written materials. This Issue Brief synthesizes key points from the day's discussion with a background paper previously prepared for Issue Dialogue participants. It focuses on the challenges and opportunities involved with ensuring language access for the growing number of people who require it. Sections include: recent immigration trends and demographic changes; the effect of language barriers on health outcomes and health care processes; laws and policies regarding the provision of language services to patients, including an overview of public financing mechanisms; strategies for improving language access, including enhancing access in delivery settings, promoting advocacy and policy change, improving interpreter training, and advancing research; and roles for foundations in supporting improved language access, including examples of current activities. The Issue Dialogue focused mainly on activities and programs that ensure linguistic access to health care for all patients. Although language and culture are clearly inseparable, a full exploration of the field of cultural competence and initiatives that promote its application to the health care setting are beyond the scope of this Issue Brief. The day's discussion did, however, raise provocative issues of culture that are reflected throughout this report.

Civil Rights↗
PubMed2005

Barriers to colorectal cancer screening: a comparison of reports from primary care physicians and average-risk adults.

BACKGROUND: Barriers to colorectal cancer (CRC) screening are not well understood. OBJECTIVES: We sought to compare barriers to CRC screening reported by primary care physicians (PCPs) and by average-risk adults, and to examine characteristics of average-risk adults who identified lack of provider recommendation as a major barrier to CRC screening. RESEARCH DESIGN: This was a comparative study using data from the 1999-2000 Survey of Colorectal Cancer Screening Practices and the 2000 National Health Interview Survey (NHIS). SUBJECTS: We recruited nationally representative samples of PCPs (n= 1235) from the SCCSP and average-risk adults (n = 6497) from the NHIS. MEASURES: We measured barriers to CRC screening identified by PCPs and average-risk adults who were not current with screening. RESULTS: Both PCPs and average-risk adults identified lack of patient awareness and physician recommendation as key barriers to obtaining CRC screening. PCPs also frequently cited patient embarrassment/anxiety about testing and test cost/lack of insurance coverage, but few adults identified these as major barriers. Of adults not current with testing, those who had visited a doctor in the past year or had health insurance were more likely to report lack of physician recommendation as the main reason they were not up-to-date compared with their counterparts with no doctor visit or health insurance. Only 10% of adults not current with testing and who had a doctor visit in the past year reported receiving a screening recommendation. CONCLUSIONS: A need exists for continued efforts to educate the public about CRC and the important role of screening in preventing this disease. Practice-based strategies to systematically prompt health care providers to discuss CRC screening with eligible patients also are required.

Aged↗
PubMed1999

MedSpanish: a language tool for the emergency department.

Language barriers frequently impede the ability of the health care professional to provide the highest quality health care to his or her patients. Spanish speaking people are rapidly becoming the largest minority population in the United States. In order to facilitate access to appropriate medical care that would not be inhibited by miscommunication or lack of a trained translator, the MedSpanish Web Site was developed for use in the Emergency Department. The site contains common Spanish vocabularies, including translations and audio clips, that would be used in such a setting. The various sections are formatted so that they could easily become pocket cards rather than relying on the availability of a computer in a medical emergency. While MedSpanish is not designed to replace a trained translator, it does offer an effective alternative if such translations services are not available.

Communication Barriers↗
PubMed2001

Barriers to treatment: the unique challenges for physicians providing dementia care.

Evaluating and treating dementia is intellectually demanding and enormously satisfying. However, physicians providing dementia care also confront unique challenges that cause discomfort and overwhelming frustration unless they are recognized and overcome. Physicians must care for individuals who do not adopt the "sick role." They must establish and maintain rapport with patients while also approaching collateral sources to obtain a complete history. They must develop a complex alliance with the patient, caregivers, community agencies, and other health professionals to provide effective treatment. Physicians must relate "bad news" to several people at once who are unequally prepared for it, while dealing with their own diagnostic uncertainty. Furthermore, physicians must honor patient autonomy and balance it with the needs of caregivers. Since the demands of providing dementia care are not typical of most medical practice, the special attributes needed are often not taught to students or adequately reimbursed by health insurance. The quality of dementia care will improve when strategies that address these aspects of care for patients with dementia are widely adopted.

Alzheimer Disease↗