Clinical Measurement of Verbal Language Proficiency in Patients Referred to a Cultural Consultation Service (CCS)

Background: The CCS of the Jewish General Hospital has been evaluating the mental health of immigrants and refugees since 1999. As may be expected, CCS patients from linguistically diverse backgrounds need interpreter services, but how clinical decisions are made to assign interpreters to a given patient are unknown. Furthermore, there are no clinical language proficiency tools available for use in health care settings. Health care literacy tools exist, but before they can be administered to patients of diverse backgrounds, basic verbal language proficiency in English must first be evaluated.

Objectives: Using a retrospective sample of CCS referrals, this study will demonstrate that clinicians overestimate language proficiency in linguistically diverse patients. Then, a simple tool to measure verbal language proficiency, which can be administered quickly and efficiently in clinical settings, will be piloted on a prospective sample of CCS referrals to address this problem.

Hypotheses: 1) The language proficiency of patients will be overestimated by referring clinicians compared to CCS clinicians; 2) The extent to which referring clinicians differ on their estimation of patients’ language proficiency will depend on several variables, including type of referring clinician and institution, patient age (older versus younger), status in Canada (refugee versus immigrant) and level of formal education; 3) The pilot language proficiency questionnaire will, on average, take less than 10 minutes per patient (clinical utility, feasibility) and will be completed by more than 80% of the approached patients who give their consent to participate in the project (clinical acceptability).

Research Methodology and Study Population: Step 1: Retrospective language data on 150 CCS referrals (over approximately five years, 2013-2017) whose mother language is other than English will be gathered by a research assistant from patient charts. Step 2: Prospective language data on approximately 50 CCS referrals (over one year, 2018-19, with anticipated increasing referral rates due to the recent influx of refugees) whose mother language is other than English will be gathered by a research assistant as per Step 1 above. In addition to comparisons of rated language proficiency between referring clinicians and the CCS clinicians, a participant observer will note the dynamics of language use during the consultation: predominant language spoken, language preferences, and how interpreters negotiate clinical communication. Step 3: Based on input from data gathered during Steps 1&2, a pilot language proficiency questionnaire, clinician-rated, brief (less than 10 minutes), and focusing on verbal language, will be drafted by the CCS researchers and administered prior to cultural consultations by a research assistant to 25 CCS referrals (over six months in 2018-19) to estimate feasibility, clinical utility and acceptability of the instrument.

Data Analysis: Descriptive statistics will be calculated for each demographic and study variable. Analysis of Variance (ANOVA) will be used to determine group differences on estimation of language proficiency. Where power considerations allow, variables from Hypothesis 2 that may influence the pattern of results will be analyzed. Measures that are scored categorically (i.e., patient’s need of an interpreter, yes/no) will be assessed using Chi-Square tests. Thematic analysis of qualitative data, gathered from participant observation, will be used to inform the development of the language proficiency questionnaire and to comment on its feasibility, clinical utility and acceptability in preparation for formal empirical testing.

Relevance: Language barriers are linked to poor mental health outcomes that are preventable if clinicians recognize which patients need interpreter services and plan ahead to provide them. A clinical tool to determine basic verbal language proficiency in English, the first of its kind, would make such interventions possible.

Clinical Measurement of Verbal Language Proficiency in Patients Referred to a Cultural Consultation Service (CCS).

The Cultural Consultation Service of the Jewish General Hospital has been evaluating the mental health of immigrants and refugees since 1999. As may be expected, CCS patients from linguistically diverse backgrounds need interpreter services, but how clinical decisions are made to assign interpreters to a given patient are unknown. Furthermore, there are no clinical language proficiency tools available for use in health care settings. Health care literacy tools exist, but before they can be administered to patients of diverse backgrounds, basic verbal language proficiency in English must first be evaluated. Using a retrospective sample of CCS referrals, this study will demonstrate that clinicians overestimate language proficiency in linguistically diverse patients. Then, a simple tool to measure verbal language proficiency, which can be administered quickly and efficiently in clinical settings, will be piloted on a prospective sample of CCS referrals to address this problem.