Jyotsna Changrani

Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial

BackgroundGrowth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction.Methods1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants.Results541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (β 0.10, 95% CI 0.02–0.18, scale 0–1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters.ConclusionsWhile not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health care.

Paan and Gutka in the United States: an emerging threat.

Smokeless tobacco and areca nut usage are integral cultural traditions in South Asia. Paan and gutka are two commonly used products which contain these ingredients. They are immensely popular in South Asia and with South Asian immigrants. Regular paan and gutka use is associated with several deleterious health consequences, most significantly oral cancer. Of particular concern is the markedly increased risk of oral cancer in South Asian immigrants when compared with the natives in new areas of settlement. The South Asian community in the United States is large and rapidly growing. Paan and gutka are legal in the United States, and readily available in ethnic enclaves. Smokeless tobacco prevention and cessation research and interventions have not yet addressed the unique sociocultural circumstances of this growing, at-risk community. The medical, dental, and public health communities need to join forces to combat this emerging threat.

Paan and Gutka Use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City

Abstract Smokeless tobacco and areca nut are popular with South Asians and South Asian immigrants, most commonly used as paan and gutka. Their regular use leads to oral cancer. The South Asian community in the U.S. is rapidly growing, where paan and gutka are readily available. The study was the first exploration of the migration of the paan and gutka habits, and their use in the U.S. A 108-item questionnaire on paan and gutka usage and beliefs was administered to 138 first-generation Bangladeshi and Indian-Gujarati immigrant adults at community sites in the New York metropolitan area. Forty-five percent Indian-Gujaratis reported ever-regular paan use; of which 5% are current users. Thirty-one percent reported ever-regular gutka use; of which 77% are current users. Thirty-five percent Bangladeshis reported ever-regular paan use; of which 70% are current users. Nine percent reported ever-regular gutka use; of which 67% are current users. Bangladeshis are more likely to identify paan as causing oral cancer. Indian-Gujaratis are more likely to identify gutka as causing oral cancer. Between the two communities, there were significant differences in paan and gutka usage, migration effects, and oral cancer risk perception. There is a need for comprehensive migration studies on the determinants of usage, and for community-specific interventions for these carcinogenic products.

New York City's immigrant minorities. Reducing cancer health disparities.

One million newcomers arrive in the United States every year; 11.7% of the total U.S. population is foreign‐born. Immigrants face cancer care and research access barriers, including economic, immigration status, cultural, and linguistic. In 2000, the Center for Immigrant Health, NYU School of Medicine, launched the Cancer Awareness Network for Immigrant Minority Populations (CANIMP), a network comprising community‐ and faith‐based organizations, local and national government health institutions, clinical service providers, researchers, and immigrant‐service and advocacy organizations. This community‐based participatory program chose as its priorities high‐ incidence cancer sites in the overall immigrant community (colorectal, lung, breast, cervical, prostate), as well as sites with strikingly high incidence in specific immigrant groups (gastric, liver, oral). CANIMP has developed successful outreach, education, screening, survivorship, training, and research programs to decrease cancer disparities. Over 2500 at‐risk community members have been reached, 25 junior minority researchers trained, 60 minority interns mentored, numerous cancer disparities research projects funded and conducted, and vital partnerships to improve cancer data developed. These initiatives serve as models to address community, systems, physician, and cancer research gaps in immigrant communities. Cancer 2006.

Reducing Clinical Errors in Cancer Education: Interpreter Training

Over 22 million US residents are limited English proficient. Hospitals often call upon untrained persons to interpret. There is a dearth of information on errors in medical interpreting and their impact upon cancer education. We conducted an experimental study of standardized medical interpreting training on interpreting errors in the cancer encounter, by comparing trained and untrained interpreters, using identical content. Nine interpreted cancer encounters with identical scripts were recorded and transcribed. Using an “Error Analysis Tool,” a bilingual linguist and two bilingual medical providers scored the transcripts for interpreting errors made, including their potential clinical severity. Trained interpreters were 70% less likely to have clinical errors than untrained ones. The likelihood of medical error increased with the length of the concept and decreased with the precision of vocabulary. It is important to train medical interpreters and to ensure their availability in cancer education encounters to minimize the risk for errors.

Drive-by readings: a creative strategy for tuberculosis control among immigrants.

OBJECTIVES We explored an innovative strategy for targeted testing and disease management among immigrant communities at risk for tuberculosis. METHODS Taxi drivers were recruited at an airport holding lot to undergo tuberculin skin testing (Mantoux). After receiving their test results in a location convenient for them, drivers with positive results were referred for evaluation and treatment. We conducted baseline and follow-up assessments. RESULTS Of 123 drivers who participated, two thirds (82) were at high risk for tuberculosis. Seventy-eight (63%) of the 123 returned for test readings; 62% of these drivers had positive test results. All drivers with positive results received a complete physician evaluation, but 64% of those evaluated were not treated for latent TB infection. Of the untreated drivers, 37.5% were at high risk. Systemic and physician barriers (e.g., lack of knowledge, erroneous beliefs regarding vaccines) affected adherence to evaluation and treatment. CONCLUSIONS Targeted testing and treatment are important to the control of tuberculosis. The results of this study highlight the need for an aggressive physician educational campaign to identify latent tuberculosis infection and to tailor service delivery to meet the unique needs of foreign-born communities.

Culturally Tailored Health Camps and Cardiovascular Risk among South Asian Immigrants

Introduction. South Asians have a high prevalence and early age of onset of diabetes, metabolic syndrome, and cardiovascular disease (CVD). We assess the potential of a culturally responsive intervention, health camps, to identify and inform U.S. South Asian community members at risk for CVD. Methods. We held four culturally and linguistically tailored health camps between October 2009 and November 2010 to educate participants about and screen for CVD risk factors, including diabetes, hypertension, and hypercholesterolemia. Data analysis was conducted in December 2010. Results. Nearly 300 (289) South Asians registered at the health camps: 20% reported a previous diagnosis of diabetes, 34% elevated blood pressure, and 22% hypercholesterolemia. Most (240) participants had their blood glucose measured; 13% had values >200 mg/dl. Most (265) had their blood pressure measured; 32% had elevated values. Over half (57%) of LDLs were <100 mg/dl. Discussion. Health camps are a potentially important component in addressing increased CVD risk in this vulnerable population.

Language Discordance and Influenza Vaccination

Growth of the foreign-born population in the United States in recent years has led to increasing numbers of limited-English-proficient (LEP) patients (US Census Bureau, 2003). Language discordance between patients and their medical providers is a major factor impeding effective provision of health care (Flores, 2005; Hampers, Cha, Gutglass, Binns, & Krug, 1999; KirkmanLiff & Mondragon, 1991; Kline, Acosta, Austin, & Johnson, 1980; Ku & Flores, 2005; Manson, 1988; Marks et al., 1987; Woloshin, Schwartz, Katz, & Welch, 1997; Yeo, 2004). Influenza infections are a major cause of mortality in the United States. In the 1990’s there were approximately 36,000 influenza-associated deaths annually (Thompson et al., 2003). Influenza vaccination is the primary method of controlling the disease, and is an important preventive health service. The New York City Department of Health and Mental Hygiene recommends priority vaccination of highest risk individuals including all people aged ≥65,

Hypertension Beliefs and Practices Among South Asian Immigrants: A Focus Group Study

South Asian immigrants are a large, rapidly growing community in the United States. The rate of cardiovascular disease in immigrants from India, Pakistan, and Bangladesh is disproportionately high. We conducted focus groups with diverse South Asian community members in New York City to elucidate hypertension knowledge, and screening and treatment practices. Focus groups were conducted in partnership with community-based organizations. 47 participants across Bangladeshi, Pakistani and Indian immigrants participated in three focus groups. Participants hesitated accessing services because of immigration fears, financial concerns, scheduling constraints, and dissatisfaction with their interactions with doctors. Discussions detailed knowledge about, and barriers to following, advice on diet and exercise. The findings compel further development of culturally- and linguistically-tailored research and interventions to address the specific needs of this large at-risk community. Potential culturally appropriate approaches are discussed to bridge barriers faced by the community.

GANY AND CHANGRANI RESPOND

As Xia writes, creative tuberculosis (TB) prevention strategies and programs are indeed necessary to reach the large numbers of medically underserved immigrants in the United States. Rates of TB among foreign-born persons in the United States continue to increase,1 and there is a vast reservoir of latent tuberculosis infection (LTBI) among immigrants.2 Many at-risk immigrants face linguistic, cultural, economic, legal, and structural obstacles to early TB screening and treatment.3 The community must be an integral partner in the planning, implementation, and evaluation of TB control programs for immigrants. These programs should include active advisory boards; formative research (e.g., focus groups and needs assessments); materials development; community capacity building and technical assistance; community-based outreach, education, and screening by trusted community members; a seamless care referral and follow-up system; and ongoing program monitoring and evaluation. The Community Tuberculosis Prevention Program (CTPP) at the Center for Immigrant Health, New York University School of Medicine, is an active partnership of community members, the New York City Department of Health and Mental Hygiene, and the Center for Immigrant Health. This partnership has enabled successful culturally and linguistically appropriate TB control interventions. CTPP goes to where the community lives, works, studies, prays, and plays. It reaches a broad range of immigrants, including many who are newly arrived and some who do not have Immigration and Naturalization Service documentation. More than 25 000 high-risk immigrants have been screened during CTPP’s 10 years of existence. When the program recently screened 400 immigrants in a church in a bustling immigrant parish in Queens, 118 individuals were found to have LTBI, and 1 active case was detected. Through CTPP’s close linkages, all received prompt evaluation and treatment. Their cases will be managed by bilingual, bicultural staff until they have completed therapy. Another CTPP initiative, the School Intervention Program, manages the cases of more than 300 high-risk immigrant high school students with LTBI per year, with an 80% therapy completion rate. The School Intervention Program also has an LTBI directly observed therapy program serving a different cohort of students, and this program has a 96% completion rate. Similar results have been described for other community-driven programs. In a cultural case management program for LTBI in Seattle, Wash, the 6-month isoniazid therapy completion rate for refugees from the former Soviet Union, the former Yugoslavia, and So-malia were reported at 82%.4 TB in the United States can be better controlled with the provision of adequate resources to ensure targeted testing of those at risk, with prompt and effective treatment and follow-up provided in a culturally and linguistically sensitive manner. Sufficient funding for such programs is necessary to reach Healthy People 2010 objectives 14–11 (to decrease the TB case rate to 1 per 100 000 people) and 14–13 (to increase the proportion of high-risk individuals with LTBI who complete therapy to 85%.)5