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Dr. Elaine Hsieh

Professor, Communication
University of Oklahoma

TEL: 405-325-3154
Email: Elaine Hsieh

RESEARCH INTERESTS

A. Overview

My research interests focus on interpersonal issues in health contexts, with an emphasis on cross-cultural care. I have been involved in research on bilingual/cross-cultural health care for over 15 years. The three aspects that I have investigated are (a) the discrepancies between the beliefs and the practice of medical interpreters and healthcare providers, (b) interpreters’ influences on the quality of health services, and (c) interpreters’ mediation of identities and communicative goals. I currently pursue two lines of research dealing with health communication for non-English speaking and/or minority patients: (a) interpreter-mediated medical encounters and cross-cultural care, and (b) social support and health literacy in cultural contexts. I am particularly interested in (a) developing a model of bilingual health communication to explain and predict the effectiveness and appropriateness of interpreter-mediated medical encounters, (b) investigating how patients’ (cultural-specific) social support and health literacy influences their coping strategies and health behaviors, and (c) generating a theoretical model of coping that accounts for the social process and temporal aspects of illness management. 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 healthcare settings.

B. Bilingual Health Communication

Core Fulbright U.S. Scholar; Arts, Education, Humanities, Professional Fields and Social Sciences-- Research (Award #5130), Taiwan; Title: Quality of Care for Interpreter-Mediated Medical Encounters in Taiwan. Sponsored by the United States Department of State Bureau of Educational and Cultural Affairs Period: 07/01/2015-01/15/2016 [Completed]

The mix-method project is part of my larger, international research program that aims to examine the barriers and facilitators to quality care for language discordant patients (i.e., patients who do not share the same language with their healthcare providers). Based on my previous NIH funded work, I am convinced that to further advance the theories and quality of care for language discordant patients, it is important to examine how specific contextual variables may shape the content and process of interpreter-mediated medical encounters. In particular, the unique demographic, sociopolitical, and sociocultural contexts of language discordant patients in Taiwan (e.g., large number of foreign residents from Southeast Asia) can provide significant insights into (a) health disparities experienced by these marginalized patients, and (b) meaningful interventions to improve the quality of care for these patients. The specific aims of the project include:

  • Examining the characteristics and practice of healthcare interpreting in Taiwan

  • Identifying the unique contextual variables that influence providers, patients, and interpreters’ attitudes, and practices of healthcare interpreting in Taiwan

  • Exploring similarities and differences in providers, patients, and interpreters’ attitudes, and practices of healthcare interpreting.

  • Generating long-term collaborations with researchers, healthcare practitioners, and local NGOs in Taiwan

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.

Interpreters' Impact on LEP Parents' Communicative Competence in Pediatric Oncology. Grant application for National Institutes of Health [R01]. [top 25th percentile]. Anticipated Period 2011-2014. Role: Principal Investigator. $1,623,501. [not funded]

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. 

C. Social Support and Health Literacy

Grant (Title: Patient Communicative Competence in Gynecologic Oncology) funded by the Stephenson Cancer Center, University of Oklahoma-Health Sciences Center. Role: Principal Investigator. Period: 01/01/2012-06/30/2012. $60,339  [completed]

Description:
This longitudinal study represents a pioneering work by examining health literacy in temporal and interpersonal contexts. We define communicative competence as the collaborative and evolving ability to acquire and use health information to achieve optimal health outcomes, which is a form of enacted health literacy. Communicative competence: (a) can empower participants to address their priorities and concerns, (b) is established through individuals’ communication, negotiation, and execution of their needs and goals, and (c) is evolving and situated in individuals’ illness experiences. The specific aim of the study is to identify changes in communicative competence over the course of an illness event. We are particularly interested in how communicative competence may evolve (a) during the emergent, dynamic interactions within a single medical encounter (e.g., sequential development of a medical discourse), and (b) over time across multiple medical encounters (e.g., changes of communicative strategies across multiple medical encounters). In addition, we are interested to examine providers’ and interpreters’ role in influencing the changes of patients’ communicative competence. Our study can provide insights into how communicative competence is not an individual property but rather an emergent characteristic of certain kinds of interaction, an area identified as critical in advancing current research.

The study includes both qualitative and quantitative research designs and incorporates a variety of data. The study represents a pioneering work by juxtaposing actual practice with the participants’ perceptions and evaluation of the quality of provider-patient communication (e.g., interviews). We will track 40 patients (i.e, 20-Spanish-speaking and 20 English-speaking patients) over an 6-month period, collecting a total of 160 video-recorded medical encounters. The total number of the medical encounters of the proposed study (n=160) is comparable to (in fact, slightly more than) other studies with similar research design for monolingual medical encounters.  We will also conduct interviews with providers and patients. The longitudinal design also provides insight into how providers, patients, and interpreters can develop effective strategies to coordinate care over time. The quantity and quality of the data is unprecedented in research on bilingual health care.

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. [not funded]

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.

 

 

  

Areas of Study

  1. Overview

  2. Bilingual Health Communication

  3. Social Support and Health Literacy

Summary: Statement of Scholarship (pdf)