Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

Background Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. Methods/Design Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. Discussion Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Critical literacy and second language learning

An introductory overview of the historical foundations, practical precedents of current 'critical' approaches to English as a Second Language teaching - with specific reference to 'critical pedagogy' and 'text analytic' work.

Rethinking comprehension and strategy use in second language listening instruction

In second language classrooms, listening is gaining recognition as an active element in the processes of learning and using a second language. Currently, however, much of the teaching of listening prioritises comprehension without sufficient emphasis on the skills and strategies that enhance learners’ understanding of spoken language. This paper presents an argument for rethinking the emphasis on comprehension and advocates augmenting current teaching with an explicit focus on strategies. Drawing on the literature, the paper provides three models of strategy instruction for the teaching and development of listening skills. The models include steps for implementation that accord with their respective approaches to explicit instruction. The final section of the paper synthesises key points from the models as a guide for application in the second language classroom. The premise underpinning the paper is that the teaching of strategies can provide learners with active and explicit measures for managing and expanding their listening capacities, both in the learning and ‘real world’ use of a second language.

The ascendancy of oracy in university courses: Implications for teachers and second language users

This chapter reports on a study of oracy in a first-year university Business course, with particular interest in the oracy demands for second language-using international students. The research is relevant at a time when Higher Education is characterised by the confluence of increased international enrolments, more dialogic teaching and learning, and imperatives for teamwork and collaboration. Data sources for the study included videotaped lectures and tutorials, course documents, student surveys, and an interview with the lecturer. The findings pointed to a complex, oracy-laden environment where interactive talk fulfilled high-stakes functions related to social inclusion, the co-construction of knowledge, and the accomplishment of assessment tasks. The salience of talk posed significant challenges for students negotiating these core functions in their second language. The study highlights the oracy demands in university courses and foregrounds the need for university teachers, curriculum writers and speaking test developers to recognise these demands and explicate them for the benefit of all students.

Error correction in second language writing : teachers’ beliefs, practices, and students’ preferences

Error correction is perhaps the most widely used method for responding to student writing. While various studies have investigated the effectiveness of providing error correction, there has been relatively little research incorporating teachers' beliefs, practices, and students' preferences in written error correction. The current study adopted features of an ethnographic research design in order to explore the beliefs and practices of ESL teachers, and investigate the preferences of L2 students regarding written error correction in the context of a language institute situated in the Brisbane metropolitan district. In this study, two ESL teachers and two groups of adult intermediate L2 students were interviewed and observed. The beliefs and practices of the teachers were elicited through interviews and classroom observations. The preferences of L2 students were elicited through focus group interviews. Responses of the participants were encoded and analysed. Results of the teacher interviews showed that teachers believe that providing written error correction has advantages and disadvantages. Teachers believe that providing written error correction helps students improve their proof-reading skills in order to revise their writing more efficiently. However, results also indicate that providing written error correction is very time consuming. Furthermore, teachers prefer to provide explicit written feedback strategies during the early stages of the language course, and move to a more implicit strategy of providing written error correction in order to facilitate language learning. On the other hand, results of the focus group interviews suggest that students regard their teachers' practice of written error correction as important in helping them locate their errors and revise their writing. However, students also feel that the process of providing written error correction is time consuming. Nevertheless, students want and expect their teachers to provide written feedback because they believe that the benefits they gain from receiving feedback on their writing outweigh the apparent disadvantages of their teachers' written error correction strategies.

Pragmatics, perceptions and strategies in Chinese college English learning

This study investigated Chinese College English students. perceptions of pragmatics, their pragmatic competence in selected speech acts, strategies they employed in acquiring pragmatic knowledge, as well as their general approach to learning English as a foreign language. The research was triggered by a national curriculum initiative that prioritizes the need for College English students to enhance their ability to use English effectively in different social interactions (Chinese College English Education and Supervisory Committee, 2007). The traditional "grammar-translation" and "examination-oriented" method is believed to have reduced Chinese College English students to what is dubbed "mute" and "deaf" language learners (Zhang, 2008; Zhao, 2009). Many students lack pragmatic knowledge on how to interpret discourse by relating utterances to their meanings, understanding the intention of language users, and how language is used in specific settings (Bachman & Palmer, 1996, 2010). There is an increasing body of literature on awareness-raising of the importance of pragmatic knowledge and strategies for classroom instruction. However, to date, researchers have tended to focus largely on the teaching of pragmatics, rather than on how students acquire pragmatic competence (Bardovi-Harlig & Dornyei, 1998; Du, 2004; Hou, 2007; Ruan, 2007; Schauer, 2009). It is this gap in the research that this study fills, with a focus on different types of pragmatic knowledge, learner perceptions of such knowledge, and learning strategies that College English students employ in the process of learning English in general, and pragmatics in particular. Three strands of theories of second language acquisition (Ellis, 1985, 1994): pragmatics (Levinson, 1983; Mey, 2001; Yule, 1996), intercultural communications (Kramsch, 1998; Samovar & Porter, 1997; Samovar, Porter & McDaniel, 2009) and English as a lingua franca (ELF) (Canagarajah, 2006; Firth, 1996; Pennycook, 2010) were employed to establish a conceptual framework for data collection and analyses. Key constructs derived from the three related theories helped to form a typology for a detailed examination and theorization of the empirical evidence gathered from different sources. Four research instruments: a questionnaire (N=237), Discourse Completion Tasks (DCTs) (N=55), focus group interviews (N=18), and a textbook tasks analysis were employed to collect data for this systematic inquiry. Data collected by different instruments were analyzed and compared by way of a triangulation to enhance its validity and reliability. Major findings derived from different sources highlighted that, although College English students were grammatically advanced language learners, they displayed limited pragmatic knowledge and a highly restricted repertoire of language learning strategies. The majority of the respondents, however, believed that pragmatic knowledge was as important as linguistic knowledge in the process of developing communicative competence for interaction in different contexts. It was argued that a combination of a less than sufficient English proficiency, limited knowledge of pragmatics, inadequate language materials and tasks, and a small stock of language learning strategies, were a major hindrance to effective learning and communication, resulting in pragmatic failures in many intercultural communication situations. As the first systematic study of how Chinese College English students learned pragmatics, the research provided a solid empirical base for developing a tentative model for the learning of pragmatics in a College English classroom in China and similar educational contexts. The model was strengthened by a unique combination of theories of pragmatics, intercultural communication and ELF. Findings from this research provided insights into how Chinese College English students perceived pragmatics in the English as foreign language (EFL) curriculum, the processes of learning, as well as strategies they utilized in developing linguistic and pragmatic knowledge and competence.

Professional development and technology in second language learning : do best practices work?

This study was undertaken to examine the influence that a set of Professional Development (PD) initiatives had on faculty use of Moodle, a well known Course Management System. The context of the study was a private language university just outside Tokyo, Japan. Specifically, it aimed to identify the way in which the PD initiatives adhered to professional development best practice criteria; how faculty members perceived the PD initiatives; what impact the PD initiatives had on faculty use of Moodle; and other variables that may have influenced faculty in their use of Moodle. The study utilised a mixed methods approach. Participants in the study were 42 teachers who worked at the university in the academic year 2008/9. The online survey consisted of 115 items, factored into 10 constructs. Data was collected through an online survey, semi-structured face-to-face interviews, post-workshop surveys, and a collection of textual artefacts. The quantitative data were analysed in SPSS, using descriptive statistics, Spearman's Rank Order correlation tests and a Kruskal-Wallis means test. The qualitative data was used to develop and expand findings and ideas. The results indicated that the PD initiatives adhered closely to criteria posited in technology-related professional development best practice criteria. Further, results from the online survey, post workshop surveys, and follow up face-to-face interviews indicated that while the PD initiatives that were implemented were positively perceived by faculty, they did not have the anticipated impact on Moodle use among faculty. Further results indicated that other variables, such as perceptions of Moodle, and institutional issues, had a considerable influence on Moodle use. The findings of the study further strengthened the idea that the five variables Everett Rogers lists in his Diffusion of Innovations model, including perceived attributes of an innovation; type of innovation decision; communication channels; nature of the social system; extent of change agents' promotion efforts, most influence the adoption of an innovation. However, the results also indicated that some of the variables in Rogers' DOI seem to have more of an influence than others, particularly the perceived attributes of an innovation variable. In addition, the findings of the study could serve to inform universities that have Course Management Systems (CMS), such as Moodle, about how to utilise them most efficiently and effectively. The findings could also help to inform universities about how to help faculty members acquire the skills necessary to incorporate CMSs into curricula and teaching practice. A limitation of this study was the use of a non-randomised sample, which could appear to have limited the generalisations of the findings to this particular Japanese context.

Estimating second language productive vocabulary size: A Capture-Recapture approach

This study provides validity evidence for the Capture-Recapture (CR) method, borrowed from ecology, as a measure of second language (L2) productive vocabulary size (PVS). Two separate “captures” of productive vocabulary were taken using written word association tasks (WAT). At Time 1, 47 bilinguals provided at least 4 associates to each of 30 high-frequency stimulus words in English, their first language (L1), and in French, their L2. A few days later (Time 2), this procedure was repeated with a different set of stimulus words in each language. Since the WAT was used, both Lex30 and CR PVS scores were calculated in each language. Participants also completed an animacy judgment task assessing the speed and efficiency of lexical access. Results indicated that, in both languages, CR and Lex30 scores were significantly positively correlated (evidence of convergent validity). CR scores were also significantly larger in the L1, and correlated significantly with the speed of lexical access in the L2 (evidence of construct validity). These results point to the validity of the technique for estimating relative L2 PVS. However, CR scores are not a direct indication of absolute vocabulary size. A discussion of the method’s underlying assumptions and their implications for interpretation are provided.

Learning Chinese as a heritage language in Australia and beyond : the role of capital

The benefits of learning and retaining heritage languages are well documented in the literature. Chinese heritage language learners’ commitment to their heritage language learning has gained significant research ground in social psychological and post-structural schools, with empirical evidence predominantly emerging from the North American contexts. There is scant sociological examination of similar problems conducted outside North America. The current study aims to make a contribution in this regard. The use of Bourdieu's sociological notion of capital in the Australian context complements the social psychological and post-structural work predominantly produced in the North American contexts. The initial quantitative sub-study analyses the impacts of various resources on the Chinese heritage language proficiency of 230 snowball-sampled Chinese Australian respondents to an online survey. The subsequent qualitative sub-study explores the profits of learning Chinese heritage language through interviews with a subset of the survey sample. Findings indicate that cultural, social, and symbolic capital significantly positively contributes to Chinese Australians’ Chinese heritage language proficiency, which, in return, produces profits in different forms of capital. The study suggests a reciprocal relationship between ‘capital’ and Chinese heritage language proficiency.