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My research interests focus on the communicative process between
various individuals during an illness event. I am particularly interested in
issues related to the cross-cultural contexts of health care and illness,
which have long histories of social inequality experienced by minority
patients and offer ample opportunities to both advance theory and affect
social change. I have been involved in research on bilingual health
communication in the past 10 years. The three aspects that I have investigated
are (a) the discrepancies between the beliefs and the practice of medical
interpreters, (b) interpreters' influences on the quality of health care
services, and (c) interpreters' mediation of conversational partners'
identities and communicative goals. In the past few years, I have also
extended my theoretical interests to examine coping as a coordinated behavior
between various parties. I am particularly interest in how social support and
health literacy is coordinated and negotiated between the patient and his/her
supportive others. I currently pursue two lines of research dealing with
health communication for non-English speaking and/or minority patients. The
issues are (a) developing a model of bilingual health communication to explain
the effectiveness and appropriateness of interpreters' communicative
strategies and (b) investigating how patients' (cultural-specific) social
support and health literacy influences their coping strategies and health
behaviors. My objective with these two lines of research is to develop theoretical
frameworks that not only explain the phenomenon of interest but also guide best practices in health care settings. |
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Grant
(#1R03MH76205-01-A1; Title: Providers' Views of the Roles of Medical
Interpreters) funded by National Institutes of Health/National Institute of
Mental Health. Role: Principal Investigator. Period: 09/01/2006-08/31/2009.
$146,417 [Completed]
Description:
The importance
of medical interpreters to improve the health literacy of patients with
limited English proficiency (LEP; e.g., through effective communication with
health care providers) has been widely recognized; however their roles and
functions are less understood and more widely debated. Although there are a
few studies that have examined how interpreters understand their roles in
health care settings, no studies have examined health care providers'
expectations for the roles of interpreters and the quality of bilingual health
communication. The objective of the study is to generate a new communication
theory that highlights providers' communicative goals during a medical
encounter and educates interpreters to respond to the providers' needs more
effectively. The specific aims of this study are (a) to assess providers'
experiences with, perceptions of, attitudes about, expectations for medical
interpreters and (b) to explore differences in these dimensions across
different medical specialties. The proposed study is a two-year project,
involving both qualitative and quantitative methods. In year one, focus groups
will be conducted with health care providers who have worked with medical
interpreters to explore their views of interpreter-mediated interactions. In
year two, based on the themes and categories developed from the focus group
interviews, the PI will develop a questionnaire to survey health care
providers about their attitudes about medical interpreters. The use of focus
groups in year one to develop and test questionnaires in year two will
increase the reliability and validity of the instrument. The specific research
questions are: (a) What are providers' experiences with and attitudes about
the communicative strategies used by interpreters?; (b) What are the criteria
used by providers to evaluate the success of bilingual health communication?;
(c) What are providers' expectations for interpreters' roles and
performances?; and (d) Do providers in different specialties vary in their
perceptions, attitudes, and expectations? Answering these questions will allow
the PI to develop a program of research that includes further developing
bilingual health communication theory and designing training programs to
increase health literacy of patients with LEP.
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Interpreters' Impact on LEP Parents'
Communicative Competence in Pediatric Oncology.
Grant application (#1R01CA151841-01) for
National Institutes of Health (PA-07-392:
Reducing Health Disparities Among Minority and
Underserved Children [R01]). Role: Principal
Investigator. Submitted in October, 2009.
Anticipated Period 06/01/2010-05/30/2013.
$1,490,742
Description:
Interpreters often are considered an essential resource in improving the health disparities experienced by children of Limited-English-Proficiency (LEP) parents and LEP population in general. As researchers have begun to recognize the complexity of bilingual health care, this longitudinal study will explore how different types of medical interpreters influence provider-patient communication and quality of care over the course of an illness event in pediatric oncology. The specific aims of this study are (a) to identify changes in the communicative competence of a LEP parent across the course of an illness event, (b) to explore the influence of interpreters on LEP parental and provider communicative competence, (c) to determine how the coordination among participants in a medical encounter influences the quality of bilingual health care, and (d) to identify specialty-specific needs and perspectives of bilingual health care. The study will include both qualitative and quantitative research designs and a variety of types of data. First, we will track 36 child patients over a 18-month period, collecting 5 video-recorded interpreter-mediated medical encounters from each patient. Second, we will conduct interviews/focus groups with providers, interpreters, and LEP parents (and the child patients) to explore effective and ineffective strategies in coordinating with each other to achieve successful care. The data will be analyzed through qualitative formative research (i.e., constant comparative analysis) and quantitative analyses (i.e., content analysis and statistical analysis). The study represents pioneering work in juxtaposing the actual practice (i.e., 180 video-recorded medical encounters) with the participants’ perceptions and evaluation (e.g., interviews). The longitudinal design also provides insights into how providers, patients, and interpreters can develop effective strategies to coordinate with each other over time. The quantity and quality of the data is unprecedented in research on bilingual health care. This study is significant because (a) it is the first longitudinal study to examine how on-going relationships can influence the effectiveness and appropriateness of bilingual health care and (b) it recognizes that successful interpreter-mediated encounters must be facilitated among all individuals involved (and thus, all participants can be a point of intervention to improve the quality of bilingual health communication). This study is exceptionally innovative because (a) it is the first empirical investigation that examines bilingual health communication by focusing on the changes and collaborations between participants to achieve communicative competence, (b) it recognizes the importance of ongoing interpersonal relationships and nonverbal behaviors in bilingual health care, and (c) it allows researchers to explore and triangulate research findings through various perspectives (e.g., observed interactions vs. participant reports; evaluations from providers, LEP parents, and interpreters). The long-term goals of the project are to develop communication models for bilingual health care in pediatric oncology, provide effective guidelines for the working with different types of interpreters, and provide training programs for patients, providers, and interpreters to enhance their communicative competence in bilingual health care.
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Grant application (#1 P20
RR024487-01; Title: Situating Health Literacy and Social Support in the
Management of Diabetes) for National Institutes of Health (Title: Centers of
Biomedical Research Excellence [CoBRE]; RFA-RR-06-002).
Role: Principal Junior
Investigator. 2nd resubmission in April, 2009. [1st revision: Priority score:
192; Scientific Evaluation rating: Excellent], $1,229,446
Description:
This proposal is the first
longitudinal study to situate a patient's changes in and management of health
literacy and social support during the progression of diabetes. The specific
aims of this study are: (a) to identify the changes in a patient’s health
literacy and social support across the course of an illness event (i.e.,
diabetes), (b) to determine how social support influences a patient's health
literacy, (c) to explore variations in the effectiveness of health literacy
and social support for the management of a chronic illness, and (d) to
identify the cultural-specific needs and perspectives of social support and
health literacy of American Indians. (The specific research questions are
presented in the Research Design and Methods section). These aims will be
addressed through qualitative formative research and quantitative surveys. The
long-term goal of the project will be to develop intervention tools that
increase health literacy by incorporating a patient's social support network
into their illness experience and improving the quality of care for patients
with diabetes. The proposed study is a five-year project, involving both
qualitative and quantitative methods. The qualitative study will include (a) 6
quarterly interviews and surveys with 80 patients who are recently diagnosed
with diabetes and 2 interviews and surveys with 160 members of their support
network over an 18-month period, and (b) follow up focus groups will be
conducted each year after the initial 18-month period.
The data will be examined using
qualitative and quantitative analysis to extract important themes and
relationships between different variables. Compared to past research on health
literacy and social support, this study is innovative because it is (a)
the first empirical investigation to situate a patient's (changes in) health
literacy and communication patterns in the progression of an illness event and
(b) the first longitudinal study that examines the moderating effects of
social support on patients' health literacy and coping. This study is
significant because it (a) focuses on an illness that disproportionately
affects American Indians, (b) investigates the role of a patient's social
support network in influencing health outcomes, (c) examines the changes in a
patient's health literacy and communicative behaviors throughout the course of
an illness event, and (d) will serve as a foundation for future interventions
to improve health literacy and outcomes for people living with diabetes.
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