Gwerfyl W. Roberts

The Researcher as Insider Versus the Researcher as Outsider: Enhancing Rigour Through Language and Cultural Sensitivity

Evidence suggests that in research studies involving minority language users, rigour is enhanced when researchers share a common language and culture with research participants and thus are considered to be “insiders”. However, it is clear that the use of “insiders” is not always possible and where the researchers and the researched do not share a common culture and language, measures can be taken to ensure that the research is rigorous. Furthermore, cultural and linguistic concordance does not in itself guarantee rigour; researchers must also demonstrate that their approach stands up to judgement against criteria that are congruent with the relevant research paradigm.

Describing chronic pain: towards bilingual practice

This paper reports on the findings of a pilot study that collated and categorised a range of Welsh-medium chronic pain descriptors and their conceptually equivalent English translations in order to provide a preliminary basis for chronic pain assessment amongst patients in the bilingual community of North West Wales. The results demonstrate the unique and complex nature of individual pain experiences and the challenges of meaningful interpretation, particularly when patient and practitioner do not share a common preferred language. Detailed analysis of the descriptors provided valuable insight into the patients world, revealing cultural patterns of beliefs and behaviours as well as the suffering associated with chronic pain. Implications for improving chronic pain assessment amongst bilingual speakers are explored.

Exploring decision making in intellectual disability nursing practice: a qualitative study.

Due to the dearth of relevant research, intellectual disability nurses may have difficulty identifying sources of evidence on which they can base their clinical decisions. The aim of the present research was to explore how intellectual disability nurses make decisions and how their decisions are influenced by evidence. The method was guided by interpretative phenomenology and the analysis adopted an idiographic approach. Twelve National Health Service intellectual disability nurses in Wales participated in semi-structured interviews. Four key themes were identified: getting to know the person; working as a team; evidence to support decision making; and understanding of evidence-based practice. In the context of the myriad of other professionals involved in caregiving, the nurses conveyed a commitment towards ensuring that the person with intellectual disability is at the centre of decision making. Although using empirical evidence to support practice was acknowledged, these nurses considered person centred decision making to be paramount.

Enhancing rigour in the validation of patient reported outcome measures (PROMs): bridging linguistic and psychometric testing

BackgroundA strong consensus exists for a systematic approach to linguistic validation of patient reported outcome measures (PROMs) and discrete methods for assessing their psychometric properties. Despite the need for robust evidence of the appropriateness of measures, transition from linguistic to psychometric validation is poorly documented or evidenced. This paper demonstrates the importance of linking linguistic and psychometric testing through a purposeful stage which bridges the gap between translation and large-scale validation.FindingsEvidence is drawn from a study to develop a Welsh language version of the Beck Depression Inventory-II (BDI-II) and investigate its psychometric properties. The BDI-II was translated into Welsh then administered to Welsh-speaking university students (n = 115) and patients with depression (n = 37) concurrent with the English BDI-II, and alongside other established depression and quality of life measures. A Welsh version of the BDI-II was produced that, on administration, showed conceptual equivalence with the original measure; high internal consistency reliability (Cronbach’s alpha = 0.90; 0.96); item homogeneity; adequate correlation with the English BDI-II (r = 0.96; 0.94) and additional measures; and a two-factor structure with one overriding dimension. Nevertheless, in the student sample, the Welsh version showed a significantly lower overall mean than the English (p = 0.002); and significant differences in six mean item scores. This prompted a review and refinement of the translated measure.ConclusionsExploring potential sources of bias in translated measures represents a critical step in the translation-validation process, which until now has been largely underutilised. This paper offers important findings that inform advanced methods of cross-cultural validation of PROMs.

Identifying priorities for establishing bilingual provision in nurse education: a scoping study.

Research evidence demonstrates that offering language choice to patients enhances the quality of healthcare provision. This has implications for the preparation of nurses for practice in bilingual settings, where legislation often leads to demands for health services in both languages and bilingual competence amongst healthcare providers. This paper reports on a scoping study of bilingual provision in nurse education in the bilingual context of Wales, UK, as a means of informing the evidence base for national strategic planning. The study incorporated three elements: (i) literature analysis (ii) policy review and (iii) stakeholder consultation (n=70). Six themes emerged from the stakeholder consultation, reflecting the main drivers and barriers associated with bilingual provision in course delivery. These themes aligned with findings identified from the policy and literature review that related to strategic, organisational and individual influences on bilingual educational provision. Strategic planning for bilingual provision in nurse education in Wales should take account of the factors that affect provision at different levels. These factors feature across bilingual settings outside the UK, thus giving the study international relevance and scope to inform the delivery of nurse education that meets the needs of wider diverse language communities.

Implementing the Evidence for Language-appropriate Health Care Systems: The Welsh Context

Like Canada, Wales, UK is a bilingual nation: the Welsh language is an important part of its national identity and legislative framework. This has implications for the delivery of public sector services, particularly in the context of health and social care, where responding to the language needs of service users is fundamental to quality health care provision. Nevertheless, despite the strengthening policy commitment for a whole-system approach towards enhancing Welsh language services, there is a paucity of evidence to guide best practice in organizational planning in health care settings.This commentary outlines the context and significance of bilingual health care provision in Wales and the implications for building and embedding the evidence base. It calls for further work to translate our knowledge and understanding of language-appropriate practice to provide more effective and sensitive health care services; and to close the implementation gap between evidence and practice. Given the relevance of this challenge for health care providers in Canada who plan and deliver services for French-language minorities, this approach has resonance across our research communities. Thus, in our common pursuit to establish integrated knowledge translation research for language-appropriate health care systems, this commentary offers a focus for reflection, discussion and collaborative action.RésuméTout comme le Canada, le pays de Galles, au Royaume-Uni, est une nation bilingue: la langue galloise est un élément important de son identité nationale et de son cadre législatif. Cette situation a des implications pour la prestation de services publics, en particulier dans le domaine des services sociaux et de santé, où il est essentiel de répondre aux besoins linguistiques des utilisateurs de services pour assurer des soins de qualité. Néanmoins, en dépit de l’engagement politique pour offrir davantage de services sociaux et de santé en gallois, on manque d’éléments qui orienteraient l’élaboration de pratiques exemplaires en matière de planification et d’organisation des services de santé.Ce commentaire décrit le contexte et l’importance de la prestation des soins de santé bilingues au Pays de Galles et les prérequis pour élaborer et intégrer une base de données probantes. Il appelle à davantage transférer et appliquer les connaissances acquises sur la pratique dans la langue appropriée pour fournir des services de santé plus efficaces et adaptés, et combler le fossé qui existe actuellement au niveau de la mise en œuvre entre la recherche et la pratique. Compte tenu de la pertinence de ce défi pour les fournisseurs de soins de santé au Canada qui planifient et fournissent des services pour les minorités de langue française, cette approche a une certaine résonnance dans nos communautés de recherche. Ainsi, dans notre quête commune de recherche et de transfert des connaissances pour mettre en place des systèmes de santé dans la langue appropriée, ce commentaire propose une mise au point pour la réflexion, la discussion et l’action en collaboration.