Culture and Health
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 20 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.
In recent years, I have been developing a new research line that emerged from my interests in legal issues in health policy. This research line centers on two issues: (1) the discrepancies between legal standards and known factors and practices for quality of care and (2) reconceptualizing privacy boundaries, patient autonomy, self-determinism, and health management in the era of genomic medicine. Going forward, I would like to examine how genetic technology and medicine present challenges to individuals’ management of health, privacy, and relationships. I am also interested in examining how institutional practices (e.g., informed consent), health policies (e.g., biobank management), and medicine in general (e.g., use and research of genetic materials) should respond to such paradigm shift in meanings of autonomy, privacy, and property interests.
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.
Patient Communicative Competence in Gynecological Oncology. Sponsored by the University of Oklahoma-Health Sciences Center/Oklahoma Tobacco Settlement Endowment Trust. Role: Principal Investigator. Period: 01/01/2012-06/30/2012. $60,335. [Completed]
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.
Providers' Views of the Roles of Medical Interpreters. Grant (#1R03MH76205-01-A1) funded by National Institute of Mental Health of the National Institutes of Health. Role: Principal Investigator. Period: 09/01/2006-08/31/2009. $146,417.[Completed]
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.
Illness as a Coordinated Family Activity: Use of Traditional Chinese Medicine by Elderly Chinese in the United States. Oklahoma Clinical and Translational Sciences Institute (OCTSI) Scholar Program funded by the Clinical and Translational Science Award Planning Grant (NIH-NCRR-1 P20 RR023477-01P) and the College of Medicine at the University of Oklahoma-Health Sciences Center. Role: Faculty mentor to OCTIS scholar: Haiying Kong. Period: 06/01/2009-07/31/2009.[Completed]