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Mobile Video interpretation to Optimize Communication Across Language barriers: mVOCAL

移动视频口译可优化跨语言障碍的沟通：mVOCAL

基本信息

批准号：
10491101
负责人：
Katherine Casey Lion
金额：
$ 80.89万
依托单位：
SEATTLE CHILDREN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-20 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10491101
关键词：
Address Adherence Adopted Adult Affect Caring Childhood Clinic Clinic Visits Communication Comprehension Diagnosis Education Effectiveness Enrollment Event Evidence based practice Face Family Goals Infrastructure Interview Knowledge Language Learning Module Legal Limited English Proficiency Link Medical Methods Modeling Online Systems Outcome Parents Pathway interactions Patients Persons Population Primary Health Care Production Provider Randomized Research Personnel Risk Safety Sequential Multiple Assignment Randomized Trial Site Surveys System Telephone Testing Theoretical Domains framework Time Uncertainty United States Video Recording Visit base behavior change compare effectiveness cost cost effective disparity reduction effectiveness implementation study effectiveness study experience handheld mobile device health care disparity health care quality health care service organization health care settings implementation strategy improved improved outcome incremental cost-effectiveness insight multi-component intervention novel patient subsets pressure primary care setting primary outcome provider behavior satisfaction skills trial design wireless

项目摘要

Project Summary Over 25 million people in the United States (US) have limited English proficiency (LEP). LEP populations face substantial barriers to high-quality healthcare, resulting in disparate outcomes such as elevated risk for serious safety events, increased costs, and decreased comprehension, satisfaction, and adherence. Professional interpretation is an evidence-based practice to improve care and mitigate these disparities. However, its use remains persistently low despite legal and regulatory mandates. Previous strategies to improve use have mainly addressed intrapersonal barriers (provider knowledge and skills, via in -person education) or the system (simplifying telephone interpreter access). Educational strategies have improved provider knowledge with unknown effect on interpreter use; systems strategies have achieved modest improvements in use. However, these strategies have lacked clearly articulated mechanisms or causal pathways, often as part of expensive, multifaceted interventions that limit precise attribution and scalability. In this study, the investigators will compare two discrete implementation strategies for improving interpreter use, the first an enhanced education strategy targeting primarily intrapersonal barriers but delivered in a scalable format (interactive web-based educational modules), and the second targeting system barriers, with a novel focus on mobile video interpretation (mVI), accessible on providers’ own mobile devices. The study’s specific aims are: (1) Compare the effectiveness of two implementation strategies, alone and in combination, to improve use of interpretation and comprehension for LEP patients/parents seen in adult/pediatric primary care settings; (2) Explore mVI and education implementation strategies’ ability to activate putative provider-level mechanisms; and (3) Determine the incremental cost effectiveness from a healthcare organization perspective of each implementation strategy (mVI, education, both). To accomplish these aims, the investigators will conduct a Type III hybrid implementation-effectiveness study in 6 primary care clinics, using a Sequential Multiple Assignment Randomized Trial (SMART) design . Enrolled providers (total n=50) will be randomized to mVI or educational modules, in addition to standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative implementation strategy. Providers will complete surveys and in-depth interviews to understand barriers to interpreter use, based on the Theoretical Domains Framework. LEP patients will be surveyed (n=648) and interviewed (n=75) following visits with enrolled providers to understand their experiences with communication and interpretation. Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, how they do so, and at what cost, will provide critical insights for addressing a persistent cause of healthcare disparities.

项目总结