How Patients With Limited English Proficiency Make Health Care Decisions: Hmong Patients' Perspectives.

INTRODUCTION: Information about how the limited English proficiency immigrants make their decisions to seek health care is not well understood. With acculturation, immigrants tend to shift their beliefs and practices towards the practices of their host country. Yet, little is known whether this holds true for the Hmong's health care decision-making. METHODS: To understand the health care decision-making process of limited English proficiency Hmong, we conducted semistructured interviews with 11 Hmong adults with limited English proficiency. Interviews were audio-recorded, transcribed, and analyzed using directed and conventional content analysis. RESULTS: We identified several themes: participants sought advice and information from family members who were proficient in English and Hmong and/or who had a health background for a treatment that they perceived to be potentially life-threatening. However, participants were more reliant on their own decision-making in medical situations that were time sensitive. Participants without immediate family asked for health advice from community members or peers who had personal experience with the health condition or treatment. CONCLUSIONS: Our findings suggest a cultural shift in Hmong health care decision-making processes from relying on clan leaders and elders to seeking out the advice of adult children and spouses. Understanding this change in cultural decision-making dynamics will help health care professionals provide more culturally competent care in areas where the Hmong community have a prominent presence.

Lessons Learned: COVID Management and Cultural Practices in the US Hmong Community.

INTRODUCTION: Racially and ethnically minoritized communities are disproportionately affected by the COVID-19 pandemic. Yet, it is not well understood how these communities are coping with and managing COVID-19. Research has shown that patients' cultural identities and practices can affect their health behaviors. CASE PRESENTATION: We report the cases of 2 Hmong patients, a middle-aged man and an elderly woman, who were diagnosed with COVID-19. Both patients used a combination of traditional remedies and Western medical treatments to combat COVID-19. DISCUSSION: It is important to recognize how culture can affect COVID-19 treatment decisions in the Hmong population. The power of social networks in disseminating inaccurate information during the pandemic is something to be aware of within the Hmong community. CONCLUSION: Hmong patients are likely to use traditional remedies passed along through virtual social platforms and word of mouth, due to poor access, limited health literacy, and low English proficiency skills. Culturally acceptable interventions are needed to improve access to health literacy interventions, including better translations of COVID-19 information for the Hmong community.

Limited English Proficient Patients' Perceptions of when Interpreters are Needed and how the Decision to Utilize Interpreters is Made.

Our objective was to describe when Hmong- and Spanish-speaking limited English proficient (LEP) patients perceive an interpreter was needed and how they perceive the decision to utilize an interpreter is made in a health care encounter. We interviewed a total of 20 LEP patients. We used a number of strategies to recruit LEP patients including posting language-appropriate flyers at clinics, sending letters to LEP patients and asking our participants to refer their family and friends to participate in our study. Tape-recorded interviews were transcribed, translated, and systematically coded using directed content analysis. Patients identified two factors that influenced LEP Hmong-and Spanish-speaking patients' perception of when interpreters were needed are as follows: (1) their self-identified level of English proficiency and (2) the anticipated complexity of the health care communication. They described three factors that they perceived influenced the decision to utilize interpreters: (1) their self-identified level of English proficiency, (2) access to interpreters; and (3) health system automation of interpreter use. The findings show that patients consider a wide variety of factors when determining if an interpreter is necessary and how the decision to utilize interpreters is made. Given that health care decision making is complex, healthcare systems need to do more to help educate LEP patients of the importance of utilizing interpreters in all healthcare encounters. Additionally, future research should to explore how patients conceptualize the need for and utilization of interpreters in order to provide LEP patients with linguistically appropriate care in ways that are sensitive to their perceptions and needs.

Western or Traditional Healers? Understanding Decision Making in the Hmong Population.

Research has documented the influence of cultural values, beliefs, and traditional health practices on immigrants' health care utilization in their host countries. We describe our findings of how Hmong immigrants to the United States make decisions about whether and when to use traditional and/or Western health services. We conducted semi-structured interviews with 11 Hmong adults. We found their decisions depended on whether they classified the illness as spiritual or not and how they evaluated the effectiveness of different treatment options for their illness. Hmong participants' expectations for effective treatment in traditional or Western health care encounters combined with physical evidence of an illness influenced their decisions and often led them to shift from one type of care to the other. Understanding cultural differences in perceptions of the causes of illnesses and the link between perceived cause and treatment is important to improving care for the Hmong population.

Limited English proficient Hmong- and Spanish-speaking patients' perceptions of the quality of interpreter services.

BACKGROUND: Language barriers are a large and growing problem for patients in the US and around the world. Interpreter services are a standard solution for addressing language barriers and most research has focused on utilization of interpreter services and their effect on health outcomes for patients who do not speak the same language as their healthcare providers including nurses. However, there is limited research on patients' perceptions of these interpreter services. OBJECTIVE: To examine Hmong- and Spanish-speaking patients' perceptions of interpreter service quality in the context of receiving cancer preventive services. METHODS: Twenty limited English proficient Hmong (n=10) and Spanish-speaking participants (n=10) ranging in age from 33 to 75 years were interviewed by two bilingual researchers in a Midwestern state. Interviews were audio taped, transcribed verbatim, and translated into English. Analysis was done using conventional content analysis. RESULTS: The two groups shared perceptions about the quality of interpreter services as variable along three dimensions. Specifically, both groups evaluated quality of interpreters based on the interpreters' ability to provide: (a) literal interpretation, (b) cultural interpretation, and (c) emotional interpretation during the health care encounter. The groups differed, however, on how they described the consequences of poor interpretation quality. Hmong participants described how poor quality interpretation could lead to: (a) poor interpersonal relationships among patients, providers, and interpreters, (b) inability of patients to follow through with treatment plans, and (c) emotional distress for patients. CONCLUSIONS: Our study highlights the fact that patients are discerning consumers of interpreter services; and could be effective partners in efforts to reform and enhance interpreter services.