Project Details

The first subproject studies how and why combinations of traditional and digital communication strategies are deemed effective in facilitating both Lifeworld and System aspects of LDCs and patient outcomes by studying migrant patients’, informal caregivers’, and healthcare professionals’ perspectives. By following the complexity science interdisciplinary approach, we take into account contextual factors (the when, how, for whom, why and for what purposes these strategies are deemed effective) by basing our research on the six-function model of medical communication, which outlines six communication functions (e.g. fostering a relationship, decision-making) along with immediate (e.g. good patient-healthcare professional relationship), intermediate (e.g. patient participation) and long term endpoints (e.g. patient satisfaction).

To explore stakeholders’ perspectives, we carry out semi-structured interviews with a heterogenous group of migrant patients, their informal caregivers and healthcare professionals. To achieve sufficient heterogeneity a purposeful sampling strategy will be employed by sampling patients from various sociocultural backgrounds and suffering from diverse health complaints (e.g. acute/chronic/severe/mild). We strive to hold separate interviews with patients’ caregivers, to enable identification of possible divergent perspectives within the same households. We will interview healthcare professionals from diverse clinical settings (i.e. general practitioners, nurses, medical specialists) who treat migrant patients with low Dutch language proficiency on a regular basis. Patients are interviewed in their mother tongue by trained bilingual research assistants.

The second subproject investigates how migrant patients, interpreters, and healthcare professionals in language discordant consultations exchange medical information and jointly coordinate mutual understanding. Moreover, it explores differences and similarities between consultations mediated by professional interpreters and consultations mediated by informal interpreters, i.e., patients’ relatives or acquaintances that provide interpretation during the consultation.

This project approaches these topics from a conversation analytical point of view and analyzes the communication strategies mentioned above in video recordings of authentic interpreter-mediated medical consultations recorded in urban hospitals in Flanders, Belgium. In doing so, it does not only address verbal information exchange and grounding strategies, but also participants’ embodied behavior. As such, the researchers in charge of this project also investigate how participants combine speech with other semiotic resources to exchange medical information and coordinate mutual understanding.

The dataset used for this study is comprised of two corpora. The first corpus considers a video corpus of authentic language discordant medical consultations mediated by a professional interpreter, which was recorded in light of the Empathic Care for All project. The second corpus, collected in light of the current project, is a multifocal eye-tracking corpus of authentic language discordant medical consultations mediated by informal interpreters.

Based on the results of the first two subprojects, we develop and evaluate a (digital) decision-aid tool in our third subproject, that enables shared decision-making between healthcare professionals and migrant patients regarding which (combination of) communication strategies to use in their specific medical consultation. This part of the project is theoretically based on the Extended Technology Acceptance Model (TAM), which outlines several determinants which increase the likelihood that a technological innovation will be accepted and used in practice (e.g. perceived ease of use, self-efficacy), and concepts that are commonly used in shared decision-making theories (e.g. explaining options, discussion of patients’ preferences). To ensure a collaborative development process in which all stakeholders equally contribute from the start to the content and format of this tool, the guiding framework will be the Spiral Technology Action Research Model (STAR), which distinguishes several evaluation cycles amongst all stakeholders to guarantee continuous improvement of the tool until it is finalized.

The tool will be pilot-tested by means of think aloud observations among a sample of Turkish-Dutch patients, carers, and general practitioners while using the tool. We focus on this migrant group and healthcare professional group not only for reasons of study feasibility, but also because the Turkish-Dutch community has the lowest Dutch language proficiency of all Dutch migrant groups and because general practitioners have a gatekeeping function and can therefore take on an advisory role toward other healthcare professionals regarding the use of effective communication strategies for a specific patient. Based on the results of the pilot-tests, the prototype of the tool will be developed, and a pilot randomized controlled trial will be carried out in general practice to evaluate the effectiveness of the tool on the communication process and patient outcomes.