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PubMed2006

Ethnic identity, resettlement stress and depressive affect among Southeast Asian refugees in Canada.

Does commitment to an ethnic identity enhance or jeopardize psychological well-being? Using data from a study of Southeast Asian "Boat People", this study examined the mental health effects of ethnic identification as the former refugees confronted common resettlement stressors in Canada--unemployment, discrimination and lack of fluency in the dominant society language. The study team administered a questionnaire to 647 respondents covering ethnic identification, demographic and employment information, language fluency, experiences with discrimination, and depressive affect. Context helped determine the relationship between ethnic identification and depressive affect. When the Southeast Asians encountered racial discrimination or unemployment, ethnic identity attachment amplified the risk of depressive affect. By contrast, a strongly held ethnic identity provided a psychological advantage for individuals experiencing difficulties with the dominant language.

Acculturation↗
PubMed2006

Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective.

We report a qualitative study of accounts of interpreted consultations in UK primary care. The study sought to explore how three Habermasian tensions between (a) system and lifeworld, (b) communicative and strategic action, and (c) interpersonal and macropolitical spheres played out in the triadic consultation between clinician, interpreter and patient. In a total of 69 individual interviews and two focus groups, we collected narratives from service users (through interpreters or bilingual researchers), interpreters and doctors and other staff in general practice. We recorded, transcribed and analysed these, taking the story as the main unit of analysis. Our data suggest that the preconditions for communicative action are rarely met in the interpreted consultation. The interpreter's presence makes a dyadic interaction into a triad, adding considerable complexity to the social situation and generating operational and technical challenges. Lack of trust, intense pressure of time, mismatch of agendas (biomedical versus lifeworld), firm expectations of a specific outcome (e.g. referral, prescription) and profound power imbalances all promote strategic action (i.e. speech that seeks consciously or unconsciously to manipulate an outcome) rather than communicative action (i.e. sincere efforts to achieve understanding, and reach consensus) by all parties. In consultations interpreted by family members (an option traditionally seen as 'second best' by policy makers), the social situation is very different. Family members are generally trusted, share the lifeworld agenda, and shift the power balance in the patient's favour. The interpreter occupies multiple social roles, including translator, interpersonal mediator, system mediator, educator, advocate, and link worker. The essence of professionalism in interpreting is shifting judiciously between these potentially conflicting roles. We discuss the implications of our findings for communication with limited English speakers in healthcare consultations and for realizing contemporary policy goals such as concordance, shared decision-making, empowerment, and choice.

Communication Barriers↗
PubMed2005

New paradigms for supporting the resilience of marine ecosystems.

Resource managers and scientists from disparate disciplines are rising to the challenge of understanding and moderating human impacts on marine ecosystems. Traditional barriers to communication between marine ecologists, fisheries biologists, social scientists and economists are beginning to break down, and the distinction between applied and basic research is fading. These ongoing trends arise, in part, from an increasing awareness of the profound influence of people on the functioning of all marine ecosystems, an increased focus on spatial and temporal scale, and a renewed assessment of the role of biodiversity in the sustainability of ecosystem goods and services upon which human societies depend. Here, we highlight the emergence of a complex systems approach for sustaining and repairing marine ecosystems, linking ecological resilience to governance structures, economics and society.

Journal Article↗
PubMed2004

Confidence in the ability to communicate with physicians among low-income patients with prostate cancer.

OBJECTIVES: To describe the confidence of low-income patients with prostate cancer in interacting with physicians. Men with prostate cancer need to communicate easily with their physicians when facing treatment decisions and symptom management; however, little is known about whether low-income men are confident in these interactions. METHODS: We used validated instruments to measure self-efficacy in patient-physician interactions, emotional well-being, symptom distress, satisfaction with care, and health-related quality of life among low-income men receiving prostate cancer treatment through a statewide public assistance program. We abstracted clinical variables from medical records. We dichotomized self-efficacy scores empirically on the basis of the sample distribution and conducted univariate and multivariate analyses. RESULTS: The self-efficacy scores were skewed toward the high scores, with 77% in the high range. Those (23%) with low self-efficacy were more likely to have poor emotional well-being, symptom distress, role limitations--emotional, low social function, and poor urinary, sexual, and bowel outcomes. In multivariate analysis, low-income men were more likely to have low self-efficacy if they were less satisfied with their care, did not have confidence in their provider, or had more symptom distress. CONCLUSIONS: Among low-income patients with prostate cancer, low self-efficacy for interacting with physicians was best predicted by diminished overall satisfaction with care, low confidence in providers, and worse symptom distress. Men with low self-efficacy fared worse over a range of psychosocial outcomes and both general and disease-specific health-related quality of life.

Adenocarcinoma↗
PubMed2002

Caring for a limited-English proficient patient.

Each day in the United States, health care workers try to communicate with patients who are deaf, hard of hearing, or limited-English proficient (LEP). According to government regulations, these patients are guaranteed access to language accommodations. The legal implications of these regulations will be discussed along with ways to facilitate communication with patients who are deaf, hard of hearing, or LEP and the requirements for those who act as interpreters for such patients.

Adult↗
PubMed1997

Perioperative nursing challenges for the Russian emigré nurse.

Three San Francisco organizations participated in an integration program that focused on the design, implementation, and evaluation of a unique training project that prepared Russian émigré nurses for employment in the US health care industry. The Russian Nurse Project is a unique program that affiliates émigré nurses with specific language and cultural skills and focuses on the increasing Russian immigrant patient population. The project's implementation and diversity strategies, as they pertain to the perioperative areas of nursing practice in this country, are described.

Communication Barriers↗
PubMedDate not supplied

[Possible factors influencing rehabilitation of the total laryngectomy patient using esophageal speech].

One of the handicaps of patients that have had a total laryngectomy is the loss of oral speech. There are three possibilities to rehabilitate these patients; surgery, voice prosthesis or esophageal speech. This last one appears as an inexpensive, non-invasive rehabilitation method; it does not need a complex learning and in spite of new technics, it continues to be an effective method in the social rehabilitation of laryngectomized patients. We have made a retrospective study of patients who underwent TL between 1992-1998 and that were rehabilitated by esophageal voice learning. Three factors have been evaluated: first, those related to the patient (gender, age, study level...); second, those related to the treatment itself [TL, pharyngolaryngectomy (PTL), TL plus radiotherapy...] and third, those related to the rehabilitation (technics, delayed on starting, number of sessions...). Data were compared with rehabilitation outcome: good (usually using esophageal voice), medium (speaking sometimes) and bad (not speaking). 74.1% had an acceptable outcome and they use esophageal voice with more or less difficulty to communicate, and this outcome increases to 95.8% when we do not take into account 7 patients who gave-up rehabilitation before finishing the first five sessions.

Adult↗
PubMed2000

Patient centeredness in medical encounters requiring an interpreter.

PURPOSE: Patient-centered interviewing is associated with greater patient satisfaction and better medical outcomes than traditional encounters, but actively seeking patients' views of their illnesses and encouraging patients to express expectations, thoughts, and feelings is difficult in encounters that require an interpreter. We sought to examine physicians' use of the patient-centered approach with patients who required the assistance of an interpreter. SUBJECTS AND METHODS: A cross-sectional sample of patients was videorecorded during visits with physicians at a multi-ethnic, university-affiliated, primary care clinic. Nineteen medical encounters of Spanish-speaking patients who required an interpreter and 19 matched English-speaking encounters were coded for frequency that patients mentioned symptoms, feelings, expectations, and thoughts (collectively called "offers"). Physicians' responses were coded as ignoring, closed, open, or facilitative of further discussion. RESULTS: English-speaking patients made a mean (+/- SD) of 20 +/- 11 offers, compared with 7 +/- 4 for Spanish-speaking patients (P = 0.001). Spanish-speaking patients also were less likely to receive facilitation from their physicians and were more likely to have their comments ignored (P <0.005). English-speaking patients usually received an answer or acknowledgment to their questions even if the physicians did not encourage further discussion on the topic. CONCLUSION: Spanish-speaking patients are at a double disadvantage in encounters with English-speaking physicians: these patients make fewer comments, and the ones they do make are more likely to be ignored. The communication difficulties may result in lower adherence rates and poorer medical outcomes among Spanish-speaking patients.

Adult↗
PubMed1999

Improving adherence to hormone replacement therapy with effective patient-physician communication.

Surgically menopausal women are 5 times more likely to begin hormone replacement therapy than are naturally menopausal women, and they continue therapy for longer periods. The primary reasons that women refuse hormone replacement are fear of cancer and perceived side effects. In contrast, withdrawal bleeding is the major reason that women discontinue hormone replacement therapy. Physician-patient communication plays an important role in a woman's decision to use hormone replacement therapy, to fill her prescription, and to adhere to the regimen. The first visit at which hormone replacement therapy is discussed is crucial to establishing an effective patient-physician relationship. At least 15 minutes, and preferably 45 minutes, should be reserved for this visit. Patient follow-up-either by phone or in person-during the first month can help improve adherence because this is when many women may have nuisance side effects and discontinue therapy.

Communication Barriers↗
PubMed1998

Making sense of schizophrenic symptoms; delusional statements and behavior may be functional in purpose.

The present paper describes the use of a functional analysis in attempting to make sense of symptomatic delusional statements and behaviors that people diagnosed with schizophrenia present. The three categories that are used to classify symptoms are: (1) positive reinforcement function, (2) negative reinforcement function, and (3) mislabeling of private events. The paper presents a number of clinical cases whose symptoms are representative of each category. Each case is then functionally treated as a result of its "category" characteristics, thus basing treatment on the hypothesized function (or reason) for the symptom.

Adult↗
PubMed2002

Knowledge and attitudes about the differences between emergency contraception and medical abortion among middle-class women and men of reproductive age in Mexico City.

Two reproductive technologies--emergency contraception and medical abortion--have the potential to reduce unintended pregnancy significantly in Latin America. Lack of knowledge and negative attitudes about the methods may limit their impact, however. Results from focus group discussions with middle-class men and women of reproductive age residing in Mexico City indicate that knowledge about emergency contraception and medical abortion is low. After being informed about both methods, participants supported emergency contraception but tied their support for medical abortion to its legal status. Participants remained concerned about the methods' efficacy, mechanism of action, and potential to encourage sexual risk-taking. While almost all desired greater dissemination of information about and access to both methods in Mexico, participants cited religious and cultural concerns, as well as barriers in communication with providers and within families, as significant challenges. Participants hoped, however, that both emergency contraception and medical abortion might play important roles in preventing unwanted pregnancy and abortion-related morbidity and mortality in Mexico in the future.

Abortifacient Agents↗
PubMed1998

EEG-based communication: analysis of concurrent EMG activity.

OBJECTIVE: Recent studies indicate that people can learn to control the amplitude of mu or beta rhythms in the EEG recorded from the scalp over sensorimotor cortex and can use that control to move a cursor to targets on the computer screen. While subjects do not move during performance, it is possible that inapparent or unconscious muscle contractions contribute to the changes in the mu and beta rhythm activity responsible for cursor movement. We evaluated this possibility. METHODS: EMG was recorded from 10 distal limb muscle groups while five trained subjects used mu or beta rhythms to move a cursor to targets at the bottom or top edge of a computer screen. RESULTS: EMG activity was very low during performance, averaging 4.0+/-4.4% (SD) of maximum voluntary contraction. Most important, the correlation, measured as r2, between target position and EMG activity averaged only 0.01+/-0.02, much lower than the correlation between target position and the EEG activity that controlled cursor movement, which averaged 0.39+/-0.18. CONCLUSIONS: These results strongly support the conclusion that EEG-based cursor control does no depend on concurrent muscle activity. EEG-based communication and control might provide a new augmentative communication option for those with severe motor disabilities.

Adult↗