Limited English Proficiency Occupational Therapy Patients Receiving Interpreter Services Perception of Quality of Care

Study Overview
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Brief Summary
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A systematic literature review from March through June 2014 supports the premise that limited English proficiency (LEP) persons face barriers and disparities to medical care that English-speaking persons do not face. Language barriers have a negative impact on health and health care, including lower health status, lower likelihood of having a primary care provider, lower rate of preventative care, higher use rate of diagnostic tests, higher rate of severe psychopathology diagnoses, and higher risk of drug complications . Additionally, LEP persons experience problems with effective communication with providers, inappropriate diagnoses and treatments, lower comprehension of medication instructions and adherence to regimens, fewer follow up visits, low quality care, poorer health outcomes, and low patient satisfaction. Research has proven a relationship between LEP and health care outcomes, specifically a relationship between positive outcomes and use of professional interpreters. Not sharing a common language creates a barrier to providing safe, effective, client-centered Occupational Therapy (OT) and knowledge of outcome satisfaction for this population. Using trained interpreters would reduce the barriers created by language discordance. This evidence-based project intends to measures the influence of interpreter service on LEP patients' perceived quality of care using a satisfaction survey. Gathered data will be used to consider development and implementation of practice guidelines for use of professional interpreter services for LEP patients receiving OT services at Midwest Orthopaedics at Rush. Development and implementation of practice guidelines that include use of trained interpreters when providing OT services to LEP patients will facilitate a client-centered approach and improve quality of care for this population. The project is also being implemented as part of a degree requirement for the Doctorate of Occupational Therapy Program at Chatham University.

Detailed Description
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The sampling frame will consist of adults, age 18 or older, with limited English proficiency (LEP), with an upper extremity injury or disorder, that have been referred to occupational therapy (OT) at Midwest Orthopaedics at Rush (MOR), require services that span four weeks or more, agree to use of interpreter services, agree to completing a paper and pencil survey at the end of four weeks, and agree to be interviewed after four weeks of occupational therapy services, following completion of the survey. LEP is determined by a preference to receive medical information in a non-English language. Sampling frame is four participants. The sampling frame will be purposive. As LEP individuals present for OT services they will be recruited for participation. Recruitment could happen simultaneously or in tandem. The comparison group sampling frame will consist of adults, age 18 or older, proficient in English, with an upper extremity injury or disorder, that have been referred to OT at MOR, and require services that span four weeks or more. English proficiency is determined by use of English as preferred language. Sampling frame is four participants. For each LEP individual recruited, the following English-speaking individual will be asked to participate. When participants in each group are recruited, further recruitment will cease. The total sampling frame will be eight. Enlisting an English proficient individual following recruitment of an LEP individual ensures having equal participation in each group. A paper and pencil survey will be administered in person at MOR after the initial occupational therapy visit and at the end of four weeks of OT services to the 4 Limited English proficient subjects and 4 English-speaking subjects, for 16 completed surveys. Completion will take place in a private room in the OT department. Subjects will self-select a 4 digit identification code that they will write in at the top of the survey. The sole purpose of the code is to match the pre-OT satisfaction survey with the post-OT satisfaction survey. No personal identification markers will be used on the surveys. Interviews will be conducted with each LEP individual following four weeks of OT services and after completion of the paper survey. No personal identification markers will be placed on the interview form. The interviews will be conducted in person at MOR, in a private room in the OT department. The primary investigator will present the open-ended questions with the assistance of Rush University Medical Center (RUMC) interpreter services. The documented data will be reviewed by the primary investigator for emerging themes that may provide insight and additional information.

Official Title
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Limited English Proficiency Occupational Therapy Patients Receiving Interpreter Services Perception of Quality of Care

Conditions
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Communication Barriers, Occupational Therapy

Intervention / Treatment
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* Other: Interpreter services


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be age 18 or older Must have a current prescription for occupational therapy (OT) that requires service for four weeks or more that span the six-week length of the project Agree to sign the project informed consent form Agree to complete the pre-OT satisfaction survey in its entirety at the conclusion of their OT initial evaluation and the post-4 weeks OT satisfaction survey at the end of four weeks of OT service Additional inclusion criteria for limited English proficiency (LEP) group: Agree to use professional interpreter services Agree to an interview at the end of four weeks of OT service Exclusion Criteria: Under 18 years of age Does not have a current prescription for occupational therapy (OT) that requires service for four weeks or more that span the six-week length of the project Refusal to sign the project informed consent form Refusal to complete the pre-OT satisfaction survey in its entirety at the conclusion of their OT initial evaluation and the post-4 weeks OT satisfaction survey at the end of four weeks of OT service Refusal of LEP participants to use professional interpreter services Refusal of LEP participants to be interviewed at the end of four weeks of OT service

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Limited English Proficiency Group<br>LEP persons were identified by asking, What language would you like to receive medical information and services in? Patients were considered limited English proficient when a non-English language was preferred. Interventions included professional interpreter services and occupational therapy. | Other: Interpreter services<br> <br> * Other names: Occupational Therapy;|
| English Speaking Group<br>English speaking persons were identified by asking, What language would you like to receive medical information and services in? Patients were considered English speaking when the English language was preferred. Intervention included occupational therapy. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pre-Occupational Therapy Satisfaction Survey | The pre-Occupational Therapy satisfaction survey was developed for this project by the primary investigator to measure perceived satisfaction. The pre-OT satisfaction survey consists of five demographic items and four items that employ a Likert scale rating method. The total quantitative scoring range for the survey is four to twenty, with a score of four indicating the lowest satisfaction and a score of 20 indicating the highest satisfaction. The paper and pencil survey was completed in person by all participants after the initial OT visit. Survey scores of the LEP group were compared to the English-speaking group. Equal or better scores reflect agreement that LEP OT perceive quality of care and satisfaction equal to English-speaking patients. | Baseline | 
| Post-4 weeks Occupational Therapy Satisfaction Survey | The Post-4 weeks OT satisfaction survey was developed for this project by the primary investigator to measure perceived satisfaction. The survey consists of five demographic items and four items that employ a Likert scale rating method. The total quantitative scoring range for the survey is 4 to 20, with a score of 4 indicating the lowest satisfaction and a score of 20 indicating the highest satisfaction. The post-4 weeks OT satisfaction survey contains three additional items, using a Likert scale rating method to explore qualitative experiences. Total qualitative scoring range for the survey is 3 to 15, with a score of 3 indicating a low belief in the benefits of OT and a score of 15 indicating a high belief in the benefits of OT. Scores of the LEP group were compared to the English-speaking group. Equal or better scores reflect agreement that LEP OT patients receiving IS perceive quality of care and satisfaction equal to English-speaking patients. | 4 weeks from baseline | 
| Occupational Therapy Satisfaction Interview | Interviews were conducted by the primary investigator, Eileen Turgeon, assisted by Interpreter Services (IS), with each LEP individual following four weeks of OT services and after completion of the post-4 weeks OT satisfaction survey. The interviews were conducted in person. The interview consisted of seven open-ended questions meant to capture the qualitative experience of the use of Interpreter Services during OT service delivery. The literature supports the use of surveys and interviews to gather feedback on LEP patients' perceived quality of care and satisfaction (González et al., 2010; Green et al., 2005; Lee et al., 2002; Shi et al., 2009; Wilson et al., 2005). The primary investigator presented the open-ended questions with the assistance of IS. The recorded interviews were reviewed by this primary investigator for emerging themes to provide insight and additional information. | 4 weeks from baseline |