Experiences of Sign Language Interpreters and Perspectives of Interpreting Administrators During the COVID-19 Pandemic: A Qualitative Description.

OBJECTIVE: Interpreting during the COVID-19 pandemic caused stress and adverse mental health among sign language interpreters. The objective of this study was to summarize the pandemic-related work experiences of sign language interpreters and interpreting administrators upon transitioning from on-site to remote work. METHODS: From March through August 2021, we conducted focus groups with 22 sign language interpreters in 5 settings, 1 focus group for each setting: staff, educational, community/freelance, video remote interpreting, and video relay services. We also conducted 5 individual interviews with interpreting administrators or individuals in positions of administrative leadership in each represented setting. The 22 interpreters had a mean (SD) age of 43.4 (9.8) years, 18 were female, 17 were White, all identified as hearing, and all worked a mean (SD) of 30.6 (11.6) hours per week in remote interpreting. We asked participants about the positive and negative consequences of transitioning from on-site to remote at-home interpreting. We established a thematic framework by way of qualitative description for data analysis. RESULTS: We found considerable overlap across positive and negative consequences identified by interpreters and interpreting administrators. Positive consequences of transitioning from on-site to remote-at-home interpreting were realized across 5 overarching topic areas: organizational support, new opportunities, well-being, connections/relationships, and scheduling. Negative consequences emerged across 4 overarching topic areas: technology, financial aspects, availability of the interpreter workforce, and concerns about the occupational health of interpreters. CONCLUSIONS: The positive and negative consequences shared by interpreters and interpreting administrators provide foundational knowledge upon which to create recommendations for the anticipated sustainment of some remote interpreting practice in a manner that protects and promotes occupational health.

Evaluation of Preferred Language and Timing of COVID-19 Vaccine Uptake and Disease Outcomes.

Importance: Beyond traditional race and ethnicity demographic characteristics, additional discrete data variables are needed for informed health interventions in the US. Objective: To examine whether COVID-19 vaccine uptake patterns and associated disease outcomes differ among language preference groups. Design, Setting, and Participants: A cohort study of 851 410 individuals aged 18 years or older in a large multispecialty health system in Minnesota and western Wisconsin was conducted between December 15, 2020, and March 31, 2022. Exposure: Self-identified language preference and limited English proficiency (LEP) as measured by interpreter need were used to create subgroups using US census categories and attention to capture languages known to represent refugee groups. Main Outcomes and Measures: The primary outcome was COVID-19 vaccination uptake rates and time to first vaccine. Secondary outcomes were rates of COVID-19-associated hospitalization and death. Results: Most of the 851 410 participants (women, 493 910 [58.0%]; median age, 29 [IQR, 35-64] years) were US-born English speakers; 7.5% were born in other countries, 4.0% had a language preference other than English (LPOE), and 3.0% indicated LEP as measured by interpreter need. Marked temporal clusters were observed for COVID-19 vaccination uptake, hospitalizations, and deaths associated with primary series vaccine eligibility, booster availability, and COVID-19 variants. Delayed first-dose vaccine was observed with LPOE (hazard ratio [HR], 0.83; 95% CI, 0.82-0.84) and interpreter need (HR, 0.81; 95% CI, 0.80-0.82) compared with those with English language preference and proficiency. Patients with LPOE were approximately twice as likely to be hospitalized (rate ratio [RR], 1.85; 95% CI, 1.63-2.08) or die (RR, 2.13; 95% CI, 1.65-2.69). Patients with LEP experienced even higher rates of hospitalization (RR, 1.98; 95% CI, 1.73-2.25) and COVID-19-associated death (RR, 2.32; 95% CI, 1.79-2.95). Outcomes varied for individual language preference groups. Conclusions and Relevance: In this study, delayed time to first-dose vaccine was associated with increased COVID-19 hospitalization and death rates for specific LPOE and LEP groups. The findings suggest that data collection of language preference and interpreter need provides actionable health intervention information. Standardized system-level data collection, including at a national level, may improve efficient identification of social groups with disproportionate health disparities and provide key information on improving health equity in the US.

Methodological reflections on the recruitment and engagement of people for cancer screening research in Wales.

Cancer is a major threat to public health and the second leading cause of death globally. Population-based cancer screening is an effective way to improve the early detection of a cancer and reduce mortality. Factors associated with participation in cancer screening have been increasingly explored in research. The challenges to undertaking such research are evident, but there is little discussion about how to address such challenges. This article discusses methodological issues associated with the recruitment and engagement of participants in research, drawing upon our experience of undertaking research exploring the support needs of people residing in Newport West, Wales, to participate in breast, bowel, and cervical screening programs. Four key areas were addressed: sampling issues, language barriers, IT issues, and time demand for participation. The paper highlights the importance of ongoing community engagement, the provision of appropriate study materials, and the adaption to different data collection modes to meet participants' needs to participate in research, thus enabling people who are usually excluded from research to have a voice and make a significant contribution to research.

"I Had to Do It All Alone": Hispanic Perspectives on Navigating Breast Cancer Treatment.

Cancer patients are at a high risk for COVID infection and its corresponding impacts on treatment delay, social isolation, and psychological distress. Hispanic breast cancer patients may be more vulnerable due to a lack of resources and language barriers, widening disparities in cancer care. This qualitative study explored the challenges and obstacles to cancer care during the COVID pandemic among 27 Hispanic females from a United States-Mexico border region. Data were collected via individual in-depth interviews and analyzed using thematic analysis. The majority of the participants were interviewed in Spanish. More than half (55.6%, n = 15) were diagnosed with breast cancer within the prior year to the interview. One-third of the participants (33.3%, n = 9) reported that COVID somewhat to greatly impacted their cancer care. Study findings revealed potential barriers and challenges for cancer care at multiple levels (e.g., medical, psychosocial, financial level) during the COVID pandemic. Five major themes reported include: (1) delays in testing and access to care; (2) fear of COVID infection; (3) social isolation and reduced social support; (4) challenges in navigating treatments alone; and (5) financial hardships. Our findings highlight the importance for health care practitioners to understand various challenges encountered by underserved Hispanic breast cancer patients due to COVID. Screening for psychological distress and exploring approaches to expand social support to address these challenges are discussed.

Interpreter use in sustained nurse home visiting: interpreter experience and support.

BACKGROUND: The aim of this study was to explore the experiences of healthcare interpreters working with child and family health nurses (CFHNs) in providing child and family health nursing (CFHN) services and sustained nurse home visiting (SNHV) programs to culturally and linguistically diverse (CALD) families with limited English proficiency. METHODS: A mixed methods longitudinal research design was conducted to develop, implement and evaluate a training and practice support model for healthcare interpreters working with nurses and CALD families in providing CFHN services and SNHV programs in three major local health services in Sydney, Australia. One pre-training survey with 24 healthcare interpreters was conducted; field notes were recorded during training and implementation; and a post-implementation focus group with six healthcare interpreters was conducted. Quantitative survey data were analysed descriptively using Alchemer. The focus group was audio-recorded for transcription purposes, and this and the field notes were thematically analysed applying a socioecological framework. RESULTS: Three themes were identified from the initial, pre-training survey: facilitate communication and delivery accurately; a bridge linking the clients and the healthcare practitioners; and make everybody feel comfortable. Practice support implementation was negatively impact by system and COVID-19 related barriers. Four themes were developed from evaluative phase of the study including: system-related issues; interpreters' challenges; working with nurses; and client session related issues. CONCLUSION: Quality interpreting was favourably influenced by adequate time for interpreting the session including a pre- and post-briefing session with CFHNs, an appropriate mode of interpretation, allocation of female interpreters and the same interpreters with CALD mothers and clarity about interpreter role and cultural comfort. These strategies support the quality of communication and relationships in delivery of CFHN services and SNHV programs to CALD mothers with limited English proficiency.

Residents' experiences of encounters with staff and communication in nursing homes during the Covid-19 pandemic: a qualitative interview study.

BACKGROUND: The Covid-19 pandemic and associated visiting restrictions have challenged communication with others for older people residing in nursing homes. AIM: The aim of this study was to explore residents' experiences of encounters and communication with staff and relatives and friends during the Covid-19 pandemic. DESIGN: An exploratory study with an inductive approach. METHODS: Semi-structured telephone interviews with 16 Swedish nursing home residents were conducted. Data were analyzed using qualitative content analysis; the study reports according to the COREQ checklist. RESULTS: Three main categories emerged: (1) Mixed feelings and experiences of encounters with nursing staff, (2) Adapting to hampered communication and finding strategies to overcome language barriers, and (3) Facing pandemic restrictions and living an adjusted life. Nine subcategories are reported within these categories. Residents mainly reported good encounters with staff and receiving the care they needed, but unhelpful encounters were also reported. To manage communication with staff with limited Swedish language skills, residents developed several strategies. During the visiting ban, residents felt secure but also lonely. Staying connected with the outside world required residents to use the phone and handle other digital aids, such as video calls, but lack of technical skills among staff hindered frequent use of video calls. CONCLUSION: This study highlights how residents can feel safe in extreme situations, but increased competence, including digital literacy and language skills, among staff is required. Care providers should provide relevant information to residents and staff and employ competent staff. Findings indicate that communication plans need to include enabling communication for residents both within and outside nursing homes, taking staff language skills into consideration.

Receiving Healthcare Amidst Poverty During the COVID-19 Lockdowns: A Culture-Centered Interrogation.

COVID-19 has exacerbated existing health inequalities globally. Guided by the culture-centered approach, this study examined perspectives and experiences of healthcare during two lockdowns in four marginalized contexts in Aotearoa New Zealand. The participants' narratives depicted dissatisfaction with the new modes of healthcare delivery, reporting longer waiting times, a preference for face-to-face delivery, language barriers, and issues with the limitations in support people attending appointments. This resulted in healthcare being delivered in a way that was not in keeping with the localized cultural norms of communication and collective support, further exacerbating existing health inequalities. Our findings suggest that public health interventions in response to COVID-19 within the context of healthcare delivery have the potential to further reify and reproduce exclusions and experiences of marginalization, with cultural marginalization reifying structural marginalization.

Experiences of Social Distancing During Coronavirus Disease 2019 as a Catalyst for Changing Long-Term Care Culture.

Purpose In this article, we draw a parallel between the experience of social isolation that occurred throughout the world during the Coronavirus Disease 2019 pandemic and similar experiences occurring in everyday life for people with communication disorders living in long-term care (LTC) facilities. We propose that speech-language pathologists can use the widespread experience of social isolation as a learning catalyst in the effort to shift the LTC culture to one that more highly values a communicative environment that is accessible to all, thereby reducing risk of social isolation for those with communication disorders. Conclusions Many training paradigms for promoting an accessible communicative environment are available in the speech-language pathology literature, yet institutional barriers exist for their widespread implementation. Overcoming these barriers is a challenge that requires awareness and learning on the part of staff and administration regarding the impact of an unfriendly communicative environment on social isolation, and the resulting psychosocial consequences. Learning theory indicates that new learning in adults is motivated by connections between personal experiences and the material to be learned. Explicitly infusing established training programs with the experience of social isolation brought on by the Coronavirus Disease 2019 pandemic may be the key needed for changing the communicative environment in LTC.

Patient and caregiver perspectives on virtual care: a patient-oriented qualitative study.

BACKGROUND: Since the onset of the COVID-19 pandemic, virtual care solutions have been rapidly adopted across the country to provide safe, quality care to diverse patient populations. The objective of this qualitative case study was to understand patient and caregiver experiences of virtual care to identify barriers and gather suggestions to address them. METHODS: In this patient-oriented project, we sought to understand gaps in virtual care experienced by patients and caregivers, using virtual focus groups. With the assistance of a patient research liaison, we engaged 2 patient partners as full partners; they participated in study conception, data collection, data analysis and knowledge translation. Recruitment was done through email by disseminating the study poster to 30 community organizations and health units in Ontario and British Columbia. We conducted a constructivist, qualitative study guided by grounded theory methodology. One researcher employed in-vivo coding, followed by axial coding with focus group participants, followed by selective coding with the study team. The study took place from November to December 2020. RESULTS: We conducted 6 focus groups with 13 patients and 5 caregivers. The analysis resulted in 6 major themes and 17 minor themes. Key findings showed that barriers related to access to technology and Internet, language and cultural differences were challenges to virtual care. Participants identified special considerations surrounding caregiver and family involvement; privacy, consent and confidentiality; and the patient-physician relationship. Participants suggested that technology and the Internet be universally accessible and that virtual care modalities be integrated (e.g., consolidated patient portal) to improve virtual care. INTERPRETATION: There are multiple patient-identified barriers to accessing virtual care in Canada; patients can provide insights into ways to address these barriers. Future research should include robust patient engagement to explore ways to address these challenges and barriers to ensure that virtual care can be equitable, accessible and safe for all users. PLAIN LANGUAGE SUMMARY: Although virtual care has been rapidly adopted and scaled up in health care institutions across the country, few improvements informed by patient and caregiver experiences have been made. Driven by concerns expressed by patient partners, our study team undertook a patient-partnered qualitative study to understand the barriers of virtual care from the perspectives and experiences of patients and caregivers. Our study team created the interview guide drawing from our previous patient-oriented qualitative studies and designed an orientation package to provide resources related to the focus groups and to introduce participants to the study team. Drawing from local health teams, clinics and patient advisory groups, the study team recruited 13 patients and 5 caregivers to participate in 6 focus group interviews. An analysis based on grounded theory was undertaken, with participation from both the study team and participants. Lack of access to technology or Internet and language barriers were determined to be the primary challenges in virtual care. Special considerations to caregiver and family involvement, privacy and confidentiality, as well as the patient-physician relationship were considered priorities to improving access to virtual care. Participants offered recommendations and potential solutions to address barriers and challenges in virtual care, which can serve to encourage large-scale policy and programmatic changes in patient-centred ways.

Assessing the Availability of Foreign and American Sign Language Interpreting Services in Community Pharmacies.

Objective To determine community pharmacists' experience with foreign language and American Sign Language (ASL) interpretation services. Design A survey was drafted to gather information about pharmacists' familiarity with ASL and foreign language interpreting services as well as the frequency with which pharmacists encountered patients who needed these services. Setting Independent and chain community pharmacies in Spokane County, Washington, USA. Participants Fifty-two community pharmacies were identified using a provider-credential search. Fifty-one pharmacists (98%) agreed to participate and completed the survey. Interventions Surveys were initially conducted in person, but after the COVID-19 pandemic began data collection was halted and restarted via phone in accordance with the Washington State University Office of Research Support and Operations. Results Four out of 51 pharmacists surveyed (7.84%) indicated that they were fluent in a language besides English. Pharmacists reported encountering patients who spoke Spanish (31%), Russian (31%), ASL (8%), Arabic (5%), Mandarin Chinese (5%), Vietnamese (5%), Marshallese (5%), and Ukrainian (2%). Some pharmacists (8%) reported not encountering patients who spoke other languages besides English. Most pharmacists (72.5%) indicated their company offered interpreting services for foreign languages, but less than half of pharmacists surveyed (43.1%) had experience using these services. Forty-five percent of pharmacists surveyed did not know whether their company offered an interpreting service for ASL, and only 23.5% indicated that they had experience using ASL interpreting services. Conclusion Pharmacists are less familiar with services for patients who speak ASL and are less likely to have experience with ASL interpretation services than they are to have assisted foreign-language-speaking patients.

Design and methods for understanding the state of cystic fibrosis care amid the COVID-19 pandemic.

BACKGROUND: Novel therapies have dramatically changed cystic fibrosis (CF) and innovative care delivery systems are needed to meet future patient needs. Telehealth has been shown to be an efficient and desirable form of care delivery. The COVID-19 pandemic caused a rapid shift to telehealth, and this presented a unique opportunity to study facilitators, barriers, and satisfaction with this mode of care delivery. We aim to report survey methods, demographics and telehealth use among CF care programs, patients, and families during the pandemic. METHODS: CF programs completed two surveys between July 29 and September 18, 2020, and between April 19 and May 19, 2021. Patients and families completed a similar survey between August 31 and October 30, 2020. The surveys addressed topics assessing the pandemic's financial impact, telehealth modes and experiences, licensure and reimbursement issues, health screening, and remote monitoring. Quantitative data were analyzed with descriptive statistics and were compared to the CF Foundation Patient Registry. RESULTS: Most programs (278 at timepoint one and 274 at timepoint two) provided telehealth during the pandemic. The percent of visits containing either telephone or video components changed from 45% to 25% over the time periods. Additionally, 424 patients and families from various ages and backgrounds responded to the survey and 81% reported having a telehealth visit. CONCLUSIONS: The pandemic accelerated telehealth adoption and these datasets are a valuable source for exploring telehealth barriers and facilitators, the quality-of-care experience, financial and workforce implications, the impact on underrepresented populations, and implications for coverage and reimbursement.

Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programs.

BACKGROUND: Cystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models. METHODS: Adult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth. RESULTS: Ninety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion. CONCLUSION: During the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.

Barriers and facilitators to implementing telehealth services during the COVID-19 pandemic: A qualitative analysis of interviews with cystic fibrosis care team members.

BACKGROUND: The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to: 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services. METHODS: We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement. RESULTS: Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients. CONCLUSIONS: A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.