School of Languages and Linguistics - Research Publications
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ItemCulturally and linguistically diverse populations in medical research: perceptions and experiences of older Italians, their families, ethics administrators and researchers(SAGE PUBLICATIONS INC, 2016)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.
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ItemA comparative discourse study of simulated clinical roleplays in two assessment contexts: Validating a specific-purpose language test(SAGE PUBLICATIONS LTD, 2016-04)The aim of this paper is to investigate from a discourse analytic perspective task authenticity in the speaking component of the Occupational English Test (OET), an English language screening test for clinicians designed to reflect the language demands of health professional–patient communication. The study compares the OET speaking sub-test roleplay performances of 12 doctors who were successful OET candidates with practice Objective Structured Clinical Examination (OSCE) roleplay performances of 12 international medical graduates (IMGs) preparing for the Australian Medical Council clinical examination. The premise for the comparison is that the OSCE roleplays can represent communication practices that are valued within the medical profession; therefore a finding of similarity in the discourse structure across the OET and the OSCE roleplays could be taken as supporting the validity of the OET as a tool for eliciting relevant communication skills in the medical profession. The study draws on genre theory as developed in Systemic Functional Linguistics (SFL) in order to compare the roleplay discourse structure and the linguistic realizations of the two tasks. In particular, it examines the role relationships of the participants (i.e. the tenor of the discourse), and the ways in which content is represented (i.e. the field of the discourse) by roleplay participants. The findings reveal some key similarities but also important differences. Although both tests inevitably fall short in terms of authentic representation of real world interactions, the findings suggest that the OET task, for a range of reasons including time allowances, training of test interlocutors, and the limits of contextual information provided to candidates, constrains candidate topic exploration and treatment negotiation, compared to the OSCE format. The paper concludes with proposals for mitigating these limitations in the interests of enhancing the OET’s capacity to elicit more professionally relevant language and communication skills.
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ItemA review of approaches to improve participation of culturally and linguistically diverse populations in clinical trials(BMC, 2016-05-26)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.
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ItemHow we developed Doctors Speak Up: an evidence-based language and communication skills open access resource for International Medical Graduates(INFORMA HEALTHCARE, 2015-01)BACKGROUND: Some International Medical Graduates (IMGs) need to develop language and communication skills for patient-centred care but have limited opportunities to do so. AIM: To develop an evidence-based, language and communication skills web resource for IMG doctors and supervisors, focussing on culturally challenging patient interviews. METHODS: Forty-eight IMGs participated in four practice OSCEs. We video-recorded the interactions and applied discourse analytic methods to investigate salient language and communication features. RESULTS: The findings from the OSCE workshops showed that many participants demonstrated aspects of patient-centred interviewing but were hindered by limited interactional competence to elicit information and negotiate behaviours as well as a limited repertoire of English grammar, vocabulary, and phonological phrasing for effective interaction. These findings guided the choice of content and pedagogy for the development of the web-based resource Doctors Speak Up. CONCLUSION: Evaluation and uptake of the Doctors Speak Up website confirm the demand for a resource combining targeted communication skills and language instruction. Over 19 500 users visited the website between March 2012 and November 2013.
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ItemPerspectives from physiotherapy supervisors on student-patient communication(INT JOURNAL MEDICAL EDUCATION-IJML, 2012)
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ItemHow Professionally Relevant Can Language Tests Be?: A Response to Wette (2011)(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2012)
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ItemDeveloping and validating language proficiency standards for non-native English speaking health professionals(ALTAANZ-ASSOC LANGUAGE TESTING & ASSESSMENT AUSTRALIA, 2013)n/a
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ItemTelecommunications as a means to access health information: an exploratory study of migrants in Australia(PAGEPRESS PUBL, 2012)BACKGROUND: Health policies increasingly promote e-health developments (e.g., consumers' access to online health information) to engage patients in their health care. In order to make these developments available for culturally and socially diverse communities, not only do Internet accessibility, literacy and e-health literacy need to be taken into account, but consumers' preferences and information seeking behaviours for accessing health information have also to be understood. These considerations are crucial when designing major new health policy directions, especially for migration destination countries with culturally diverse populations, such as Australia. The aim of this study was to examine how people from a culturally and linguistically diverse (CALD) community use telecommunications (phone, mobile, Internet) to access health information. DESIGN AND METHODS: A case study was conducted using a questionnaire exploring the use of telecommunications to access health information among CALD people. The study was carried out at a community health centre in a socially and economically disadvantaged area of Melbourne, a city of 4 million people with a large CALD and migrant population. Questionnaires were translated into three languages and interpreters were provided. Fifty-nine questionnaires were completed by users of the community health centre. RESULTS: Most of the CALD participants did not have access to the Internet at home and very few reported using telecommunications to access health information. CONCLUSIONS: The findings of the study suggest that telecommunications are not necessarily perceived to be an important channel for accessing health information by members of the CALD community.