Date Presented 04/04/19
This presentation will share findings from a descriptive, mixed-methods study involving clinical and health services experts, physical rehabilitation practitioners, and patients with limited English proficiency (LEP). The study identified clinical indicators and challenges related to optimal delivery of physical rehabilitation services for patients with LEP. Professional, practice, and policy implications of these findings will be discussed.
Primary Author and Speaker: Mansha Mirza
Additional Authors and Speakers: Elizabeth Harrison
PURPOSE: Nearly 20% of US residents speak a language other than English, many of who are deemed “limited English proficient” (LEP). Despite federal mandates for language-appropriate healthcare, language barriers create significant health disparities for LEP individuals. Existing research on this topic has focused on healthcare settings such as emergency departments, primary care, and surgical care. Much of this research is inapplicable to rehabilitation services, including occupational therapy, and there is little empirical evidence to identify appropriate language interventions in these settings.
This study aimed to:
1. Identify indicators related to optimal delivery of physical rehabilitation services for LEP patients
2. Understand challenges faced by LEP patients and physical rehabilitation providers
DESIGN: A descriptive, mixed-method study was conducted using a concurrent triangulation design. Purposive and snowball sampling strategies were used to recruit (1) 30 experts with five or more years of clinical experience in physical rehabilitation and/or at least two academic publications on healthcare services for LEP patients; (2) 13 occupational and physical therapy clinicians working in adult physical rehabilitation with at least three LEP patient encounters in the previous 6 weeks; and (3) 7 adult Spanish-speaking patients who had received OT or PT services within the previous 12 months.
METHOD: Quantitative data collection involved a 3-round Delphi survey. In round 1, an online open-ended questionnaire was used to identify clinical indicators of linguistically accessible rehabilitation services for LEP patients. Study investigators categorized responses as ‘structural’, ‘process’, and ‘outcomes’ indicators. Round 2 involved an online poll asking respondents to rate each indicator on a 7-point scale ranging from 1 (not at all important) to 7 (extremely important). Using Delphi analytic methods, the median importance score and interquartile range (IQR) was computed for each indicator. In round 3, indicators with a median score ≥ 6(IQR ≥2) were returned for rescoring in the light of group opinion. Qualitative data collection involved one patient focus group and three clinician focus groups of 60-90 minutes. Focus groups were semi-structured, were audiorecorded, and transcribed verbatim. Transcripts were analyzed using a qualitative description approach with two coders identifying categories informed by study questions and by emerging data.
RESULTS: 46 indicators (15 structural, 13 process, and 18 outcome) were identified through the Delphi process. Ten indicators achieved a median importance rating of 7 or higher with high consensus (IQR<2). The majority of these were structural indicators. Examples include administrative assistance for scheduling interpreters, and policies that allow adequate time for encounters involving LEP patients. Focus group data revealed salient themes related to ‘getting by’ without formal language services. While patients appreciated clinician efforts for getting by, clinicians expressed guilt and self-doubt. Other themes related to working with language interpreters, challenges encountered, and recommendations for improving rehabilitation services for LEP patients.
CONCLUSION: There is a need for structural changes and administrative support to facilitate language access in physical rehabilitation settings. Clinicians also need guidance on when and how to effectively use language services without compromising patient care and privacy. This study lays the groundwork for determining which language access interventions are effective during rehabilitation encounters and for developing training and workflow interventions that can address clinician barriers affecting language access.
References
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). Thousand Oaks, CA: Sage
Mirza, M., & Harrison, E. (in press). Working with clients with limited English proficiency: Mapping language access in Occupational Therapy. Occupational Therapy in Health Care. doi:10.1080/07380577.2018.1434722. [Epub ahead of print]
Okoli, C., & Pawlowski, S. D. (2004). The Delphi method as a research tool: an example, design considerations and applications. Information & management, 42(1), 15-29.
Sandelowski, M (2010). What's in a name? Qualitative description revisited. Research in Nursing & Health, 33, 77–84.
