The Impact of Language Discordance on an Occupational Therapy Care Encounter

To investigate patient, provider, and caregiver perspectives on providing care to diverse populations within occupational therapy (OT) practice.

Effective communication is essential for high-quality patient-centered care and strong therapeutic alliances, yet it is impeded by patient–provider language discordance. The rapidly increasing diversity of the U.S. population highlights the need to prioritize and investigate high-quality, patient-centered care in the presence of language discordance.

A descriptive case study approach was used (Yin, 2008).

Practitioner referrals identified Spanish monolingual patients with caregivers actively attending OT appointments. The case study included a patient, his wife, the treating Level II fieldwork student and her fieldwork educator (n = 4).

Data collection included semistructured interviews, clinical observations, and field notes. The patient, caregiver, and student were interviewed three times within the 6-wk study. The fieldwork educator was interviewed once. The 45-min interviews took place after OT sessions, occurred in English or Spanish per participant preference, and were audiorecorded and transcribed. Topics included expectations for, and experiences with, OT care. Triangulation drew on unstructured observations, field notes, and participant perspectives for all treatment sessions during the study (Mulhall, 2003; Thurmond, 2001).

Transcripts were analyzed independently and then as a group for common themes. Specifically, initial codes were developed, analyzed, and grouped. Candidate themes were developed, reviewed, and compared with coded data. Finally, themes were compared with observation and field notes for verification (Braun & Clarke, 2006; Hsieh & Shannon, 2005). Preliminary interpretations were member checked by the patient and caregiver (Creswell & Miller, 2000).

Difficulties in communication caused by language discordance impeded patient-centered care. Four themes and two subthemes emerged: (1) expectations for care, describing perceptions of OT and goal setting; (2) the therapy relationship, describing the therapeutic alliance; (3) professional identity, discussing challenges to professional identity; and (4) pragmatic constraints, addressing personal- and organizational-level contexts.

Effective communication is essential for patient-centered, high-quality care. Occupational therapy practitioners can build on their intimate knowledge of the interactions between patient-specific factors and contexts. It is imperative that our profession consider the patient perspective and examine its own practices as part of strengthening its commitment to providing high-quality care to patients from all walks of life.

This proposal investigates patient, caregiver, and provider perspectives regarding OT care to diverse populations. This perspective is essential for successful, client-centered quality initiatives aimed at improving outcomes and health disparities within vulnerable groups.

References

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. http://dx.doi.org/10.1191/1478088706qp063oa

Creswell, J. W., & Miller, D. L. (2000) Determining validity in qualitative inquiry. Theory Into Practice, 39, 124–130. http://dx.doi.org/10.1207/s15430421tip3903_2

Hsieh, H.-F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277–1288. http://dx.doi.org/10.1177/1049732305276687

Mulhall, A. (2003). In the field: Notes on observation in qualitative research. Journal of Advanced Nursing, 41, 306–313. http://dx.doi.org/10.1046/j.1365-2648.2003.02514.x

Thurmond, V. A. (2001). The point of triangulation. Journal of Nursing Scholarship, 22, 253–258. http://dx.doi.org/10.1046/j.1365-2648.2003.02514.x

Yin, R. K. (2008). Case study research design: Design and methods (4th ed.). Thousand Oaks, CA: Sage.